Healthcare Provider Details

I. General information

NPI: 1932130523
Provider Name (Legal Business Name): MICHAEL C CIOCI MSPT, CSCS, CERT MDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 E 1ST ST
OSWEGO NY
13126-1112
US

IV. Provider business mailing address

3 W SENECA ST
OSWEGO NY
13126-1536
US

V. Phone/Fax

Practice location:
  • Phone: 315-216-6688
  • Fax: 315-216-6703
Mailing address:
  • Phone: 315-216-6688
  • Fax: 315-216-6703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0274081
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: