Provider Demographics
NPI:1598333759
Name:LOCASCIO, ROY S
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:S
Last Name:LOCASCIO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ROY
Other - Middle Name:
Other - Last Name:LOCASCIO LMT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5401 HARBORAGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5401 HARBORAGE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4546
Practice Address - Country:US
Practice Address - Phone:239-595-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37822225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist