Provider Demographics
NPI:1902913007
Name:RICCI, DENISE (PT)
Entity Type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:
Last Name:RICCI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WHITESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-4107
Mailing Address - Country:US
Mailing Address - Phone:732-797-2505
Mailing Address - Fax:732-831-8747
Practice Address - Street 1:16 WHITESVILLE RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-4107
Practice Address - Country:US
Practice Address - Phone:732-797-2505
Practice Address - Fax:732-831-8747
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01196700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02720785Medicaid
NYQ28T01Medicare ID - Type Unspecified