Provider Demographics
NPI:1720608797
Name:PUCCI, CHRISTINA (ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:PUCCI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 MINUET CIR
Mailing Address - Street 2:
Mailing Address - City:VOLO
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5916
Mailing Address - Country:US
Mailing Address - Phone:847-345-2674
Mailing Address - Fax:
Practice Address - Street 1:1770 N HICKS RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-2339
Practice Address - Country:US
Practice Address - Phone:847-776-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960035102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer