Provider Demographics
NPI:1285714733
Name:CHIOCCARIELLO, CARMINE J (RPT)
Entity type:Individual
Prefix:
First Name:CARMINE
Middle Name:J
Last Name:CHIOCCARIELLO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-5400
Mailing Address - Country:US
Mailing Address - Phone:727-647-1441
Mailing Address - Fax:727-327-2897
Practice Address - Street 1:7500 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5400
Practice Address - Country:US
Practice Address - Phone:727-369-8145
Practice Address - Fax:727-327-2897
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT11189225100000X
FLPT11189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5744ZMedicare PIN