Provider Demographics
NPI:1659348928
Name:RAMOS, RICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:RICHELLE
Middle Name:
Last Name:RAMOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RICHELLE
Other - Middle Name:R
Other - Last Name:CUBILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPY
Mailing Address - Street 1:149 TECEIRA WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7716
Mailing Address - Country:US
Mailing Address - Phone:551-404-1518
Mailing Address - Fax:
Practice Address - Street 1:149 TECEIRA WAY
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-7716
Practice Address - Country:US
Practice Address - Phone:551-404-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01102100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ105650QCBMedicare PIN
NJ105650S30Medicare PIN