Provider Demographics
NPI:1336776632
Name:SANTUCCI, ANTHONY (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:SANTUCCI
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 1:2582 PINE LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-9795
Mailing Address - Country:US
Mailing Address - Phone:330-354-1992
Mailing Address - Fax:
Practice Address - Street 1:1500 CANTON RD STE 350
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4089
Practice Address - Country:US
Practice Address - Phone:330-784-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH008130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist