Healthcare Provider Details

I. General information

NPI: 1982429353
Provider Name (Legal Business Name): RICARDO LOCCI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 8TH AVE STE 300
NEW YORK NY
10036-7000
US

IV. Provider business mailing address

1229 JOHNSON FERRY RD STE 202
MARIETTA GA
30068-5416
US

V. Phone/Fax

Practice location:
  • Phone: 212-245-1841
  • Fax:
Mailing address:
  • Phone: 470-275-5015
  • Fax: 628-239-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number530586
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number530586
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: