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Individual

MRS. SALLY MICUCCI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.T.

Contact information

Practice address
59 PAGE HILL RD, BERLIN, NH 03570-3531
(603) 326-5738
Mailing address
57 RAYCREST DR, RANDOLPH, NH 03593-5213
(603) 466-2824

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1996
NH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1996
PT LICENCE
NH
Enumeration date
02/20/2007
Last updated
07/08/2007
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