MEDICARE: ANNETTE MARIE BUCCI MSPT, CERT-MDT

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	018842-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306894266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE MARIE BUCCI MSPT, CERT-MDT

Provider Business Mailing Address
First Line	:	42 SARATOGA RD
Second Line	:
City	:	SCOTIA
State	:	NY
Zip	:	12302-3412
Country	:	US
Telephone Number	:	518-399-6861
Fax Number	:	518-399-6864

Provider Business Practice Location Address
First Line	:	1182 TROY SCHENECTADY RD
Second Line	:	SUITE LL02
City	:	LATHAM
State	:	NY
Zip	:	12110-1000
Country	:	US
Telephone Number	:	518-220-9705
Fax Number	:	518-220-9651

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	09/22/2011

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