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General NPI Number Information
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NPI Number | 1124662051
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Entity Type | Individual
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Provider Name | LISA MARIE RICIGLIANO PTA
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Gender | Female
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 155 W HUDSON AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1609
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Country | US
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Telephone | 201-638-3417
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Fax | 855-232-8604
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Provider Business Mailing Address
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Address Line | 155 W HUDSON AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1609
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Country | US
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Telephone | 201-638-3417
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Fax | 855-232-8604
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00139500
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License Number State | NJ
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