Basic Information
| Provider Information | |||||||||
| NPI: | 1275166944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CULOTTA | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | WALLACE | ||||||||
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| Credential: | DPT | ||||||||
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| OtherLastName: | CULOTTA | ||||||||
| OtherFirstName: | PATRICK | ||||||||
| OtherMiddleName: | WALLACE | ||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 306393 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372306393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156560388 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5541 GROVE BLVD STE C2 | ||||||||
| Address2: | |||||||||
| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352264600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052776870 | ||||||||
| FaxNumber: | 2052776871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2020 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH9721 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.