Provider Demographics
NPI:1205080678
Name:GENNOCRO, JOSEPH M (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:GENNOCRO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 72ND CT E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-7998
Mailing Address - Country:US
Mailing Address - Phone:941-962-6622
Mailing Address - Fax:
Practice Address - Street 1:1299 BENEVA RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-3152
Practice Address - Country:US
Practice Address - Phone:941-951-0283
Practice Address - Fax:941-331-4314
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT14313Other0000