MEDICARE: KATRINA A MARICOCCHI PT, DPT

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		OH

General Provider Information

NPI Number	:	1295350445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA A MARICOCCHI PT, DPT

Provider Business Mailing Address
First Line	:	4953 SECTION AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4953 SECTION AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2120
Country	:	US
Telephone Number	:	513-712-9200
Fax Number	:

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

Provider Enumeration Date	:	06/13/2020
Last Update Date	:	06/13/2020

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