Provider Demographics
NPI:1407355258
Name:DICICCO, ANNE MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MICHELLE
Last Name:DICICCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BELCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:08230-1519
Mailing Address - Country:US
Mailing Address - Phone:609-513-7208
Mailing Address - Fax:
Practice Address - Street 1:601 S ROUTE 9
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2349
Practice Address - Country:US
Practice Address - Phone:609-463-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00743400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist