Provider Demographics
NPI:1528253457
Name:PAOLUCCI, NICOLA (PTA, LMT, CLTLANA)
Entity type:Individual
Prefix:MR
First Name:NICOLA
Middle Name:
Last Name:PAOLUCCI
Suffix:
Gender:M
Credentials:PTA, LMT, CLTLANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 AVILA RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-1661
Mailing Address - Country:US
Mailing Address - Phone:561-659-5595
Mailing Address - Fax:
Practice Address - Street 1:311 GOLF RD
Practice Address - Street 2:FLAGLER INSTITUTE
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5501
Practice Address - Country:US
Practice Address - Phone:561-833-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 20804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist