Provider Demographics
NPI:1598745572
Name:COLUCCINI, JODY ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:ANN
Last Name:COLUCCINI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518
Mailing Address - Country:US
Mailing Address - Phone:914-763-5941
Mailing Address - Fax:914-763-5332
Practice Address - Street 1:890 ROUTE 35
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518
Practice Address - Country:US
Practice Address - Phone:914-763-5941
Practice Address - Fax:914-763-5332
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ63031Medicare UPIN