Healthcare Provider Details

I. General information

NPI: 1023197985
Provider Name (Legal Business Name): DEBORAH LYNN PUCCI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E SUPERIOR ST RM 1561
CHICAGO IL
60611-2654
US

IV. Provider business mailing address

75 E HARRIS AVE
LA GRANGE IL
60525-2470
US

V. Phone/Fax

Practice location:
  • Phone: 312-238-6012
  • Fax: 312-238-1516
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: