Provider Demographics
NPI:1003647678
Name:PANUCCI, DANTE CRAIG (DPT)
Entity type:Individual
Prefix:
First Name:DANTE
Middle Name:CRAIG
Last Name:PANUCCI
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 1:1130 REDDOUR ST APT 303
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4651
Mailing Address - Country:US
Mailing Address - Phone:412-616-2164
Mailing Address - Fax:
Practice Address - Street 1:5750 CENTRE AVE STE 450
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3721
Practice Address - Country:US
Practice Address - Phone:412-665-8035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist