Provider Demographics
NPI:1689245938
Name:RICONALLA, SEPTIS
Entity Type:Individual
Prefix:
First Name:SEPTIS
Middle Name:
Last Name:RICONALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 MARKHAM WOODS RD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2843
Mailing Address - Country:US
Mailing Address - Phone:352-229-4621
Mailing Address - Fax:
Practice Address - Street 1:500 VILLAGE PL
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-6171
Practice Address - Country:US
Practice Address - Phone:407-682-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist