Provider Demographics
NPI:1831262146
Name:PATULLO, THOMAS (AP OTR)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:PATULLO
Suffix:
Gender:M
Credentials:AP OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3872 SHERIDAN STREET
Mailing Address - Street 2:FLORIDA BALANCE CENTERS INC DBA ACUPUNCTURE & INTEGRAI
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-987-7077
Mailing Address - Fax:954-987-7044
Practice Address - Street 1:3872 SHERIDAN STREET
Practice Address - Street 2:FLORIDA BALANCE CENTERS INC DBA ACUPUNCTURE & INTEGRAI
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-987-7077
Practice Address - Fax:954-987-7044
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1162171100000X
FLOT1273225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z3241OtherBCBS OCCUPATIONAL THERAPY
C0559OtherBCBS ACUPUNCTURE
P05018Medicare UPIN
C0559OtherBCBS ACUPUNCTURE