Provider Demographics
NPI:1780938654
Name:RUCCI, PAUL M (MS, ATC,PES)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:M
Last Name:RUCCI
Suffix:
Gender:M
Credentials:MS, ATC,PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1407
Mailing Address - Country:US
Mailing Address - Phone:207-834-4117
Mailing Address - Fax:207-834-3829
Practice Address - Street 1:110 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1407
Practice Address - Country:US
Practice Address - Phone:207-834-4117
Practice Address - Fax:207-834-3829
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT4522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer