MEDICARE: MR. JOHN VICCHIO PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA00526100	NJ

General Provider Information

NPI Number	:	1033179403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN VICCHIO PT

Provider Business Mailing Address
First Line	:	490 SCHOOLEYS MOUNTAIN RD STE 3B
Second Line	:
City	:	HACKETTSTOWN
State	:	NJ
Zip	:	07840-4002
Country	:	US
Telephone Number	:	908-852-7575
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 MOUNT KEMBLE AVE
Second Line	:
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960-6667
Country	:	US
Telephone Number	:	973-538-8877
Fax Number	:	973-538-8873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	10/10/2024

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