Healthcare Provider Details

I. General information

NPI: 1013892686
Provider Name (Legal Business Name): DOMINIC POCCI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15255 N 40TH ST STE 123
PHOENIX AZ
85032-4638
US

IV. Provider business mailing address

PO BOX 412313 SUITE 102
BOSTON MA
02241-0001
US

V. Phone/Fax

Practice location:
  • Phone: 480-502-5361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP053964T
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058232T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: