Provider Demographics
NPI:1114230950
Name:ARRICIVITA, LIEZL SORIANOSOS (RPT, PTA)
Entity Type:Individual
Prefix:
First Name:LIEZL
Middle Name:SORIANOSOS
Last Name:ARRICIVITA
Suffix:
Gender:F
Credentials:RPT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-4382
Mailing Address - Country:US
Mailing Address - Phone:559-978-8091
Mailing Address - Fax:
Practice Address - Street 1:682 AVALON DR
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-4382
Practice Address - Country:US
Practice Address - Phone:559-978-8091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33949225100000X
CAAT8121225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant