MEDICARE: ERIC BOCCADIFUOCO PT

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

General Provider Information

NPI Number	:	1326743121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC BOCCADIFUOCO PT

Provider Business Mailing Address
First Line	:	620 SW LAKE CHARLES CIR
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-3429
Country	:	US
Telephone Number	:	917-583-7945
Fax Number	:

Provider Business Practice Location Address
First Line	:	1537 NE CEDAR ST
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-4808
Country	:	US
Telephone Number	:	772-332-1000
Fax Number	:

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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