Provider Demographics
NPI:1497181390
Name:FUCCELLO, RHONDA (PT)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:FUCCELLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7277 NC HIGHWAY 42
Mailing Address - Street 2:208
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-7527
Mailing Address - Country:US
Mailing Address - Phone:919-773-4086
Mailing Address - Fax:919-773-4087
Practice Address - Street 1:7277 NC HIGHWAY 42
Practice Address - Street 2:208
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-7527
Practice Address - Country:US
Practice Address - Phone:919-773-4086
Practice Address - Fax:919-773-4087
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist