MEDICARE: TIMOTHY DAVID GENECCO MSPT

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	PT12379	FL

General Provider Information

NPI Number	:	1811992514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY DAVID GENECCO MSPT

Provider Business Mailing Address
First Line	:	6 WIANNO WAY
Second Line	:
City	:	SCITUATE
State	:	MA
Zip	:	02066-1520
Country	:	US
Telephone Number	:	561-373-6308
Fax Number	:	866-757-9692

Provider Business Practice Location Address
First Line	:	56 NEW DRIFTWAY
Second Line	:
City	:	SCITUATE
State	:	MA
Zip	:	02066-4533
Country	:	US
Telephone Number	:	781-544-3434
Fax Number	:	781-544-3946

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	02/07/2012

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