Provider Demographics
NPI:1659886968
Name:RICCIO, TESSA (DPT)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:RICCIO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1681 WASHINGTON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-7951
Mailing Address - Country:US
Mailing Address - Phone:339-987-4856
Mailing Address - Fax:339-987-4858
Practice Address - Street 1:1681 WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-7951
Practice Address - Country:US
Practice Address - Phone:339-987-4856
Practice Address - Fax:339-987-4858
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230712081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine