Provider Demographics
NPI:1851903710
Name:MARTUCCI, JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MARTUCCI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:MARTUCCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:106 MILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3420
Mailing Address - Country:US
Mailing Address - Phone:203-812-9377
Mailing Address - Fax:
Practice Address - Street 1:175 SHERMAN AVE FL 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4358
Practice Address - Country:US
Practice Address - Phone:203-812-9377
Practice Address - Fax:203-867-5254
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist