Provider Demographics
NPI:1396137550
Name:BIRICOCCHI, CHARLANNE KATHY (DPT)
Entity type:Individual
Prefix:
First Name:CHARLANNE
Middle Name:KATHY
Last Name:BIRICOCCHI
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 1:1505 BALLARD CT
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7938
Mailing Address - Country:US
Mailing Address - Phone:336-661-5328
Mailing Address - Fax:
Practice Address - Street 1:1505 BALLARD CT
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7938
Practice Address - Country:US
Practice Address - Phone:336-661-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist