Provider Demographics
NPI:1700169794
Name:CARLUCCI, CHRISTOPHER GREGORY (RPTA)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GREGORY
Last Name:CARLUCCI
Suffix:
Gender:M
Credentials:RPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 GUILFORD DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2586
Mailing Address - Country:US
Mailing Address - Phone:301-645-9495
Mailing Address - Fax:
Practice Address - Street 1:12021 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4210
Practice Address - Country:US
Practice Address - Phone:301-292-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1162225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant