MEDICARE: DR. WILLIAM TABARY CUCULLU DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1578209938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM TABARY CUCULLU DPT

Provider Business Mailing Address
First Line	:	14570 POWERS RD
Second Line	:
City	:	CLINTON
State	:	LA
Zip	:	70722-5354
Country	:	US
Telephone Number	:	225-245-2849
Fax Number	:

Provider Business Practice Location Address
First Line	:	42276 VETERANS AVE
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1423
Country	:	US
Telephone Number	:	985-549-6852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2022
Last Update Date	:	05/11/2022

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