MEDICARE: MRS. JODY ANN COLUCCINI 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	6740	NY

General Provider Information

NPI Number	:	1598745572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JODY ANN COLUCCINI PT

Provider Business Mailing Address
First Line	:	PO BOX 104
Second Line	:
City	:	CROSS RIVER
State	:	NY
Zip	:	10518
Country	:	US
Telephone Number	:	914-763-5941
Fax Number	:	914-763-5332

Provider Business Practice Location Address
First Line	:	890 ROUTE 35
Second Line	:
City	:	CROSS RIVER
State	:	NY
Zip	:	10518
Country	:	US
Telephone Number	:	914-763-5941
Fax Number	:	914-763-5332

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

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/08/2008

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