Provider Demographics
NPI:1811106941
Name:CARMINE CHIOCCARIELLO PT PA
Entity type:Organization
Organization Name:CARMINE CHIOCCARIELLO PT PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHIOCCARIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-313-0438
Mailing Address - Street 1:780 94TH AVE N STE 112
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2468
Mailing Address - Country:US
Mailing Address - Phone:718-313-0438
Mailing Address - Fax:727-327-2897
Practice Address - Street 1:780 94TH AVE N STE 112
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2468
Practice Address - Country:US
Practice Address - Phone:727-288-6279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11189225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0816273OtherAETNA
FLY920FOtherBCBS
FLFS890AMedicare PIN