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General NPI Number Information
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NPI Number | 1386416972
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Entity Type | Individual
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Provider Name | DR. JOHN RICCIUTI JR.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 10616 METROMONT PKWY
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City | CHARLOTTE
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State | NC
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Zip | 28269-7656
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Country | US
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Telephone | 980-938-0693
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Fax |
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Provider Business Mailing Address
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Address Line | 605 JETTON ST
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City | DAVIDSON
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State | NC
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Zip | 28036-9335
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Country | US
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Telephone |
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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