Provider Demographics
NPI:1992023196
Name:RICCI-HALE, JULIET ANGELICA (LMT)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:ANGELICA
Last Name:RICCI-HALE
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 1:235 W TUNDRA RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-5382
Mailing Address - Country:US
Mailing Address - Phone:575-524-6864
Mailing Address - Fax:
Practice Address - Street 1:1990 E LOHMAN AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3172
Practice Address - Country:US
Practice Address - Phone:575-524-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4773225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist