MEDICARE: MATTHEW COLOSIMO

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	225200000X	Physical Therapy Assistant	PTA23341	FL

General Provider Information

NPI Number	:	1598639387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW COLOSIMO

Provider Business Mailing Address
First Line	:	160 SE VIA VISCONTI
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 SE VIA VISCONTI
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5319
Country	:	US
Telephone Number	:	561-459-0753
Fax Number	:

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

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/03/2025

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Directions to “ MATTHEW COLOSIMO ” Practice Location

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