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General NPI Number Information
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NPI Number | 1639183445
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Entity Type | Individual
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Provider Name | DOMENIC VISOCCHI MSPT
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 5 HIGH ST SUITE 203
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City | MEDFORD
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State | MA
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Zip | 02155-3860
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Country | US
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Telephone | 781-395-7333
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Fax | 781-395-7331
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Provider Business Mailing Address
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Address Line | 5 HIGH ST SUITE 203
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City | MEDFORD
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State | MA
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Zip | 02155-3860
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Country | US
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Telephone | 781-395-7333
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Fax | 781-395-7331
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 15414
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License Number State | MA
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