Provider Demographics
NPI:1205970571
Name:MOROCCO, AMY (PT, DPT,MS, ATC, PES)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MOROCCO
Suffix:
Gender:F
Credentials:PT, DPT,MS, ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5684
Mailing Address - Country:US
Mailing Address - Phone:978-287-6170
Mailing Address - Fax:
Practice Address - Street 1:30 GREAT RD
Practice Address - Street 2:SPORTS & PHYSICAL THERAPY ASSOCIATES
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5684
Practice Address - Country:US
Practice Address - Phone:978-287-6170
Practice Address - Fax:978-287-1476
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00001272255A2300X
CT009116225100000X
MA19928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA19928OtherLICENSE