Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 416 | CO |
NPI | 1568680452 |
---|---|
Provider Name | Mr. Anthony Michael Ricci |
First Address | Colorado Springs, CO 80919-3313 |
Second Address | Colorado Springs, CO 80919-3313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |