Healthcare Provider Details

I. General information

NPI: 1811644313
Provider Name (Legal Business Name): ADRIANA LILY CICCONE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8116 RITCHIE HWY
PASADENA MD
21122-6916
US

IV. Provider business mailing address

9669 SWEET APPLE LN NE
LELAND NC
28451-6305
US

V. Phone/Fax

Practice location:
  • Phone: 443-261-2220
  • Fax:
Mailing address:
  • Phone: 412-726-3236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7093
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30322
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP21046
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: