Healthcare Provider Details

I. General information

NPI: 1982329124
Provider Name (Legal Business Name): RICHARD JOSEPH RYCZEK LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1271 S WARD CT
LAKEWOOD CO
80228-3839
US

IV. Provider business mailing address

1271 S WARD CT
LAKEWOOD CO
80228-3839
US

V. Phone/Fax

Practice location:
  • Phone: 704-467-7496
  • Fax:
Mailing address:
  • Phone: 704-467-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0025336
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: