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General NPI Number Information
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NPI Number | 1053472209
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Entity Type | Organization
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Legal Business Name | MATTHEW COLUCCI P.T.,P.C.
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 15 DIXIE LN
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City | EAST ISLIP
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State | NY
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Zip | 11730-2518
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Country | US
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Telephone | 516-380-8450
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Fax | 631-650-1791
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Provider Business Mailing Address
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Address Line | 15 DIXIE LN
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City | EAST ISLIP
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State | NY
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Zip | 11730-2518
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Country | US
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Telephone | 516-380-8450
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Fax | 631-650-1791
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MATTHEW F. COLUCCI
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Credential | P.T.
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Telephone | 516-380-8450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 011517
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License Number State | NY
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