Provider Demographics
NPI:1457447971
Name:RICCIO, CAROL (MS, PT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:RICCIO
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KILOLANI LANE #302
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5116
Mailing Address - Country:US
Mailing Address - Phone:808-264-0275
Mailing Address - Fax:
Practice Address - Street 1:8 KILOLANI LANE #302
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-5116
Practice Address - Country:US
Practice Address - Phone:808-264-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 1730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI022260-4OtherHMSA PROVIDER NUMBER