Provider Demographics
NPI:1891063806
Name:RICCI, JYLEAH R (LMT)
Entity Type:Individual
Prefix:MS
First Name:JYLEAH
Middle Name:R
Last Name:RICCI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8955 RIDGELINE BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2365
Mailing Address - Country:US
Mailing Address - Phone:720-488-4100
Mailing Address - Fax:
Practice Address - Street 1:8955 RIDGELINE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2365
Practice Address - Country:US
Practice Address - Phone:720-488-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3965225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist