Provider Demographics
NPI:1558016675
Name:SANCHO, MAISIE NOELLE RICAFORT (RPT)
Entity Type:Individual
Prefix:
First Name:MAISIE NOELLE
Middle Name:RICAFORT
Last Name:SANCHO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 GIESLER RD APT 3
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3619
Mailing Address - Country:US
Mailing Address - Phone:714-814-1416
Mailing Address - Fax:
Practice Address - Street 1:665 GIESLER RD APT 3
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3619
Practice Address - Country:US
Practice Address - Phone:714-814-1416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012891A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist