Provider Demographics
NPI:1942261300
Name:ULLUCCI, PAUL A JR (PT, LATC, SCS, CSCS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:ULLUCCI
Suffix:JR
Gender:M
Credentials:PT, LATC, SCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 WAMPANOAG TRL
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1231
Mailing Address - Country:US
Mailing Address - Phone:401-433-1500
Mailing Address - Fax:401-433-1517
Practice Address - Street 1:1235 WAMPANOAG TRL
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-1231
Practice Address - Country:US
Practice Address - Phone:401-433-1500
Practice Address - Fax:401-433-1517
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI948225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports