Provider Demographics
NPI:1164845277
Name:CICCARELLA, EMILY (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CICCARELLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 GLENWATER DR
Mailing Address - Street 2:APT 304
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-3149
Mailing Address - Country:US
Mailing Address - Phone:716-725-5689
Mailing Address - Fax:
Practice Address - Street 1:38 SHERIDAN PARK CIR
Practice Address - Street 2:SUITE C
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7022
Practice Address - Country:US
Practice Address - Phone:843-815-5628
Practice Address - Fax:843-815-5637
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist