Provider Demographics
NPI:1467586891
Name:RICO, GRACE A (PT, MPT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:A
Last Name:RICO
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58-200 NAPOONALA PL
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-8707
Mailing Address - Country:US
Mailing Address - Phone:808-638-0935
Mailing Address - Fax:
Practice Address - Street 1:45-691 KEAAHALA RD RM 30
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3569
Practice Address - Country:US
Practice Address - Phone:808-233-5495
Practice Address - Fax:808-233-5494
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1145522225100000X
HIPT 3378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist