Healthcare Provider Details

I. General information

NPI: 1043764608
Provider Name (Legal Business Name): JOSEPH RIVIECCIO PT, DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N PLAINS INDUSTRIAL RD
WALLINGFORD CT
06492-2360
US

IV. Provider business mailing address

PO BOX 417594
BOSTON MA
02241-7594
US

V. Phone/Fax

Practice location:
  • Phone: 203-817-0196
  • Fax:
Mailing address:
  • Phone: 646-780-0926
  • Fax: 212-379-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040735
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: