MEDICARE: AMANDA COCOZZO 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	023221-1	NY

General Provider Information

NPI Number	:	1578545265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA COCOZZO PT

Provider Business Mailing Address
First Line	:	176 DURHAM RD
Second Line	:
City	:	STILLWATER
State	:	NY
Zip	:	12170-1418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	218 S CENTRAL AVE
Second Line	:
City	:	MECHANICVILLE
State	:	NY
Zip	:	12118-3522
Country	:	US
Telephone Number	:	518-664-1188
Fax Number	:	518-664-1187

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	05/07/2008

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