Provider Demographics
NPI:1255343307
Name:TUCCI, JOAN CAROL (LMT)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:CAROL
Last Name:TUCCI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1505
Mailing Address - Country:US
Mailing Address - Phone:585-768-2734
Mailing Address - Fax:
Practice Address - Street 1:8 ELM ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1505
Practice Address - Country:US
Practice Address - Phone:585-768-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013390-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9395615OtherINDEPENDENT HEALTH
NY159368GGOtherPREFERRED CARE