Provider Demographics
NPI:1033141452
Name:RICCHIUTO, MICHAEL A (MPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:RICCHIUTO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3392 SAXONBURG BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-3145
Mailing Address - Country:US
Mailing Address - Phone:412-794-8352
Mailing Address - Fax:412-794-8056
Practice Address - Street 1:3392 SAXONBURG BLVD
Practice Address - Street 2:
Practice Address - City:GLENSHAW
Practice Address - State:PA
Practice Address - Zip Code:15116-3145
Practice Address - Country:US
Practice Address - Phone:412-794-8352
Practice Address - Fax:412-794-8056
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04-467273174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA095014S0GMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #