Provider Demographics
NPI:1720381403
Name:COCOZZO PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:COCOZZO PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COCOZZO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-441-2955
Mailing Address - Street 1:218 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-3522
Mailing Address - Country:US
Mailing Address - Phone:518-664-1188
Mailing Address - Fax:518-664-1187
Practice Address - Street 1:218 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-3522
Practice Address - Country:US
Practice Address - Phone:518-664-1188
Practice Address - Fax:518-664-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0232211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty