MEDICARE: MR. GREGORY MARIO POLICICCHIO PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT003688L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134165996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY MARIO POLICICCHIO PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	1607 LOWRIE ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-4362
Country	:	US
Telephone Number	:	412-321-9088
Fax Number	:	412-321-9445

Provider Business Practice Location Address
First Line	:	1607 LOWRIE ST
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-4362
Country	:	US
Telephone Number	:	412-321-9088
Fax Number	:	412-321-9445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/08/2007

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