Provider Demographics
NPI:1972639086
Name:TUCCIO, ANDREW MARK (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:MARK
Last Name:TUCCIO
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PINEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1081
Mailing Address - Country:US
Mailing Address - Phone:508-767-9906
Mailing Address - Fax:
Practice Address - Street 1:12 PINEBROOK LN
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1081
Practice Address - Country:US
Practice Address - Phone:508-767-9906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH 1354-AT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer