Healthcare Provider Details

I. General information

NPI: 1801960562
Provider Name (Legal Business Name): ANTHONY CRAIG PERCOCO MS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 MAIN ST
ROWLEY MA
01969-1503
US

IV. Provider business mailing address

217 MAIN ST
ROWLEY MA
01969-1503
US

V. Phone/Fax

Practice location:
  • Phone: 617-730-5337
  • Fax: 617-730-5461
Mailing address:
  • Phone: 914-763-5941
  • Fax: 914-763-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number11601
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0244071
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: