=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942261300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL A ULLUCCI JR. DPT, PHD, ATC, SCS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2006
-----------------------------------------------------
Last Update Date | 03/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 OLD SOMERSET AVE
-----------------------------------------------------
City | NORTH DIGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02764-1866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-822-1135
-----------------------------------------------------
Fax | 508-822-4115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 572 OLD SOMERSET AVE
-----------------------------------------------------
City | NORTH DIGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02764-1824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-487-3582
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 948
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2251S0007X
-----------------------------------------------------
Taxonomy Name | Sports Physical Therapist
-----------------------------------------------------
License Number | 948
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 9020
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------