MEDICARE: MR. CHAD COLUCCI 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	1391642	TX

General Provider Information

NPI Number	:	1851254791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHAD COLUCCI DPT

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:	630-912-6927
Fax Number	:

Provider Business Practice Location Address
First Line	:	9291 GARLAND RD STE 110
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-2850
Country	:	US
Telephone Number	:	972-979-6577
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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