Provider Demographics
NPI:1528296282
Name:COCCI, AMANDA BETH (DPT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:BETH
Last Name:COCCI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BETH
Other - Last Name:LEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY
Mailing Address - Street 2:STE 307
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:610-580-5200
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:8019 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2786
Practice Address - Country:US
Practice Address - Phone:215-338-8900
Practice Address - Fax:215-338-8923
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102373130-0001Medicaid
PA2123200OtherHIGHMARK PA BLUE SHIELD
PA1528296282OtherBRAVO
PA3744632000OtherIBC
306177OtherUNISON
PAP00921742Medicare PIN
PA102373130-0001Medicaid