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General NPI Number Information
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NPI Number | 1356554240
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Entity Type | Individual
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Provider Name | REBECCA LYNN CICCHETTI PT
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 2568 S RIDGEWOOD SUITE 1
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City | EDGEWATER
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State | FL
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Zip | 32141
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Country | US
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Telephone | 386-423-0100
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Fax | 386-428-8831
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Provider Business Mailing Address
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Address Line | 5431 CANNA COURT
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City | PORT ORANGE
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State | FL
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Zip | 32128-6690
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Country | US
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Telephone | 860-794-8153
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT23350
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License Number State | FL
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