Provider Demographics
NPI:1235170861
Name:MARTUCCI, DENNIS J (PT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:J
Last Name:MARTUCCI
Suffix:
Gender:M
Credentials:PT
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Other - Credentials:
Mailing Address - Street 1:1765 OLD WEST BROAD ST BLDG 2-200
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2887
Mailing Address - Country:US
Mailing Address - Phone:706-549-1663
Mailing Address - Fax:706-546-8792
Practice Address - Street 1:705 BREEDLOVE DR STE 200
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2080
Practice Address - Country:US
Practice Address - Phone:770-554-5009
Practice Address - Fax:706-546-8792
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2024-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPT004176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10616692OtherCAQH NUMBER