MEDICARE: BETH COCCI DPT

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	037249	NY

General Provider Information

NPI Number	:	1164852398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH COCCI DPT

Provider Business Mailing Address
First Line	:	293 WOODHULL AVE
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-1328
Country	:	US
Telephone Number	:	610-256-1989
Fax Number	:

Provider Business Practice Location Address
First Line	:	293 WOODHULL AVE
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-1328
Country	:	US
Telephone Number	:	610-256-1989
Fax Number	:

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

Provider Enumeration Date	:	11/25/2013
Last Update Date	:	11/25/2013

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