Provider Demographics
NPI:1972226694
Name:PASCUCCI, VICTOR (PT)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:PASCUCCI
Suffix:
Gender:M
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:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:912-729-1333
Mailing Address - Fax:
Practice Address - Street 1:100 LINDSEY LN STE A
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-1727
Practice Address - Country:US
Practice Address - Phone:912-729-1333
Practice Address - Fax:912-729-5259
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist