Provider Demographics
NPI:1134165996
Name:POLICICCHIO, GREGORY MARIO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:MARIO
Last Name:POLICICCHIO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:1607 LOWRIE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4362
Mailing Address - Country:US
Mailing Address - Phone:412-321-9088
Mailing Address - Fax:412-321-9445
Practice Address - Street 1:1607 LOWRIE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4362
Practice Address - Country:US
Practice Address - Phone:412-321-9088
Practice Address - Fax:412-321-9445
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT003688L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01929209Medicaid
PA01929209Medicaid