Healthcare Provider Details

I. General information

NPI: 1528296282
Provider Name (Legal Business Name): AMANDA BETH COCCI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA BETH LEIGH

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 FRANKFORD AVE
PHILADELPHIA PA
19136-2786
US

IV. Provider business mailing address

1377 MOTOR PKWY STE 307
ISLANDIA NY
11749-5258
US

V. Phone/Fax

Practice location:
  • Phone: 215-338-8900
  • Fax: 215-338-8923
Mailing address:
  • Phone: 610-580-5200
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019897
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: