Healthcare Provider Details

I. General information

NPI: 1578209938
Provider Name (Legal Business Name): WILLIAM TABARY CUCULLU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42276 VETERANS AVE
HAMMOND LA
70403-1423
US

IV. Provider business mailing address

14570 POWERS RD
CLINTON LA
70722-5354
US

V. Phone/Fax

Practice location:
  • Phone: 985-549-6852
  • Fax:
Mailing address:
  • Phone: 225-245-2849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: