Individual
DOMENIC VISOCCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
5 HIGH ST, SUITE 203, MEDFORD, MA 02155-3860
(781) 395-7333
(781) 395-7331
Mailing address
5 HIGH ST, SUITE 203, MEDFORD, MA 02155-3860
(781) 395-7333
(781) 395-7331
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
15414
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
469253
TUFTS
MA
01
—
Y67923
BCBS OF MASS
MA
01
—
Y6860901
MEDICARE P TAN
MA
Enumeration date
07/28/2006
Last updated
05/01/2019
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