Provider Demographics
NPI:1003276379
Name:TUCALIUC, DANIELA (LMT)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:TUCALIUC
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-1440
Mailing Address - Country:US
Mailing Address - Phone:937-901-5254
Mailing Address - Fax:
Practice Address - Street 1:1334 ROMBACH AVE
Practice Address - Street 2:STE B
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-1992
Practice Address - Country:US
Practice Address - Phone:937-901-5254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33021444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist