Provider Demographics
NPI:1356996672
Name:CHIRICHELLO, RUTH MARIE (PYA)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:MARIE
Last Name:CHIRICHELLO
Suffix:
Gender:F
Credentials:PYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12605 TIMBER PINE TR
Mailing Address - Street 2:ADDRESS 2
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4706
Mailing Address - Country:US
Mailing Address - Phone:561-436-4316
Mailing Address - Fax:
Practice Address - Street 1:12605 TIMBER PINE TR
Practice Address - Street 2:ADDRESS 2
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4706
Practice Address - Country:US
Practice Address - Phone:561-436-4316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23885225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant