Provider Demographics
NPI:1518385301
Name:PICO, MA RIZA (PT)
Entity type:Individual
Prefix:
First Name:MA RIZA
Middle Name:
Last Name:PICO
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:PO BOX 7911
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20792-7911
Mailing Address - Country:US
Mailing Address - Phone:301-877-3422
Mailing Address - Fax:301-877-3425
Practice Address - Street 1:7700 OLD BRANCH AVE
Practice Address - Street 2:SUITE A-104
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1628
Practice Address - Country:US
Practice Address - Phone:301-877-3422
Practice Address - Fax:301-877-3425
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist