Provider Demographics
NPI:1275166944
Name:CULOTTA, PATRICK WALLACE (DPT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:WALLACE
Last Name:CULOTTA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:WALLACE
Other - Last Name:CULOTTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-656-0388
Mailing Address - Fax:
Practice Address - Street 1:5541 GROVE BLVD STE C2
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-4600
Practice Address - Country:US
Practice Address - Phone:205-277-6870
Practice Address - Fax:205-277-6871
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH9721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist