Jesse David Carlucci, PTA

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

2110477 Issued in TX

Practice address

303 Lantern Bend Dr
Houston, TX 77090-2823

Phone

(518) 852-4284

NPI assigned

Jul 18, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jesse David Carlucci Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1912632548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16912 TABLELAND TRL",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773852010",
            "telephone_number": "518-852-4284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 LANTERN BEND DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770902823",
            "telephone_number": "518-852-4284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLUCCI",
        "first_name": "JESSE",
        "middle_name": "DAVID",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-18",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TX",
            "license": "2110477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSE",
            "last_name": "CARLUCCI",
            "middle_name": "DAVID",
            "credential": "PTA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brittany Nicole Carlton
• Carter Eugene Carlton Jr., M.D.
• Ray Anthony Carlton II, RN
• Rebecca Aileen Carlton
• Samantha Carlton, MD
• Susan H Carlyle, M.D.
• Cindy L. Carmack, PHD
• Roberto Carmagnani Pestana
• Pamela Carmain, M.D.
• Cristal Ann Carman, PA-C

• Physical Medicine & Rehabilitation Physician in Houston, TX
• Providers in Houston, TX by specialty
• Physical Medicine & Rehabilitation Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.