Provider Demographics
NPI:1770316804
Name:MARTUCCI, DONNA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:MARTUCCI
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 1:1143 LILLIBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-7019
Mailing Address - Country:US
Mailing Address - Phone:631-807-5598
Mailing Address - Fax:
Practice Address - Street 1:1143 LILLIBRIDGE DR
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-7019
Practice Address - Country:US
Practice Address - Phone:631-807-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8414225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant