Provider Demographics
NPI:1578209938
Name:CUCULLU, WILLIAM TABARY (DPT)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:TABARY
Last Name:CUCULLU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14570 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-5354
Mailing Address - Country:US
Mailing Address - Phone:225-245-2849
Mailing Address - Fax:
Practice Address - Street 1:42276 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1423
Practice Address - Country:US
Practice Address - Phone:985-549-6852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist