MEDICARE: PROSPER PHYSICAL THERAPY SPECIALISTS, LLC

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	:	1568162972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSPER PHYSICAL THERAPY SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	7724 CHAPEL HILL RD
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-6256
Country	:	US
Telephone Number	:	607-201-6613
Fax Number	:

Provider Business Practice Location Address
First Line	:	7724 CHAPEL HILL RD
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27513-6256
Country	:	US
Telephone Number	:	984-999-1101
Fax Number	:	984-244-2992

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JOSEPH VILLECCO
Credential	:	PT, DPT, OCS
Telephone Number	:	607-201-6613

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	05/05/2023

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