Provider Demographics
NPI:1508288317
Name:CICCO, JODIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:CICCO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10229 E 39TH WAY
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-5454
Mailing Address - Country:US
Mailing Address - Phone:412-610-5519
Mailing Address - Fax:
Practice Address - Street 1:1380 S CASTLE DOME AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-2024
Practice Address - Country:US
Practice Address - Phone:928-259-7758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2023-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ010825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist