MEDICARE: COCOZZO PHYSICAL THERAPY, PC

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	0232211	NY

General Provider Information

NPI Number	:	1720381403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COCOZZO PHYSICAL THERAPY, PC

Provider Business Mailing 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

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	:	PRESIDENT/PHYSICAL THERAPIST
Name	:	AMANDA A COCOZZO
Credential	:	PT
Telephone Number	:	518-441-2955

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	12/17/2010

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