Provider Demographics
NPI:1255088829
Name:BARTUCCI, NELLINA (PTA)
Entity type:Individual
Prefix:
First Name:NELLINA
Middle Name:
Last Name:BARTUCCI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17W070 FERN ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7033
Mailing Address - Country:US
Mailing Address - Phone:630-880-0139
Mailing Address - Fax:630-321-0249
Practice Address - Street 1:17W070 FERN ST
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7033
Practice Address - Country:US
Practice Address - Phone:630-880-0139
Practice Address - Fax:630-321-0249
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160002949225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant