Basic Information
| Provider Information | |||||||||
| NPI: | 1700169794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARLUCCI | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | GREGORY | ||||||||
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| Credential: | RPTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3226 GUILFORD DR | ||||||||
| Address2: | |||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206022586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016459495 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12021 LIVINGSTON RD | ||||||||
| Address2: | |||||||||
| City: | FORT WASHINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207444210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012920300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2011 | ||||||||
| LastUpdateDate: | 09/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | A1162 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.