Provider Demographics
NPI:1174012538
Name:PAOLUCCI, MICHAEL THOMAS (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:PAOLUCCI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:THOMAS
Other - Last Name:COSGROVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:622 TUXEDO AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-1116
Mailing Address - Country:US
Mailing Address - Phone:330-451-9580
Mailing Address - Fax:
Practice Address - Street 1:3428 W MARKET ST
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3339
Practice Address - Country:US
Practice Address - Phone:330-668-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant