Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2665-19 | WI |
NPI | 1013407444 |
---|---|
Provider Name | Deanna M Huff-Ricchio |
First Address | Kenosha, WI 53144-3922 |
Second Address | Kenosha, WI 53144-1654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2018 |
Last Update Date | 21/04/2021 |