Provider Demographics
NPI:1104086057
Name:SACCOCCIO, ERICA NEVILLE (DPT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:NEVILLE
Last Name:SACCOCCIO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 1/2 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-8525
Mailing Address - Country:US
Mailing Address - Phone:617-894-1250
Mailing Address - Fax:
Practice Address - Street 1:40 1/2 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-8525
Practice Address - Country:US
Practice Address - Phone:617-894-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist