Provider Demographics
NPI:1538809744
Name:RICALTON, MARIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:RICALTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 ECHO LAKE RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795
Mailing Address - Country:US
Mailing Address - Phone:959-209-4318
Mailing Address - Fax:
Practice Address - Street 1:777 ECHO LAKE RD
Practice Address - Street 2:SUITE I
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795
Practice Address - Country:US
Practice Address - Phone:959-209-4318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist