MEDICARE: DR. DESIREA D CAUCCI 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	PT015693	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5630094	OTHER	PA	FIRST HEALTH
2	C01732275	OTHER	PA	HIGHMARK BLUE SHIELD
3	1417588	OTHER	PA	HIGHMARK BS INDIVIDUAL
4	3498858	OTHER	PA	AETNA NON-PARTICIPATING #
5	737511	OTHER	PA	NCPPO
6	7385670	OTHER	PA	AETNA WC INDIVIDUAL
7	8279722	OTHER	PA	CIGNA
8	1732275	OTHER	PA	HIGHMARK BS GROUP #
9	700260	OTHER	PA	UNITED HEALTHCARE/ACN GR
10	017588	OTHER	PA	AMERIHEALTH ADMINISTRATOR
11	2402306	OTHER	PA	INDEPENDENCE BC GROUP #
12	7051525	OTHER	PA	AETNA WORKERS COMP
13	0220700	OTHER	PA	ORTHONET
14	2103996000	OTHER	PA	INDEPENDENCE BC INDIVIDUA

General Provider Information

NPI Number	:	1881699213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DESIREA D CAUCCI DPT

Provider Business Mailing Address
First Line	:	217 S TYSON AVE
Second Line	:
City	:	GLENSIDE
State	:	PA
Zip	:	19038-3413
Country	:	US
Telephone Number	:	215-630-9797
Fax Number	:	610-828-7505

Provider Business Practice Location Address
First Line	:	814 FAYETTE ST
Second Line	:
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428-1709
Country	:	US
Telephone Number	:	610-828-7595
Fax Number	:	610-828-7505

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/21/2022

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