Provider Demographics
NPI:1144399866
Name:CATUCCIO, PETER W (ATC, LAT,PTA, CSCS)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:W
Last Name:CATUCCIO
Suffix:
Gender:M
Credentials:ATC, LAT,PTA, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LORELEI CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2733
Mailing Address - Country:US
Mailing Address - Phone:203-264-0435
Mailing Address - Fax:
Practice Address - Street 1:140 LORELEI CT
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2733
Practice Address - Country:US
Practice Address - Phone:203-264-0435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer