Provider Demographics
NPI:1457106775
Name:RICCARDO, CRISTIN (MSG)
Entity Type:Individual
Prefix:
First Name:CRISTIN
Middle Name:
Last Name:RICCARDO
Suffix:
Gender:F
Credentials:MSG
Other - Prefix:
Other - First Name:CRISTIN
Other - Middle Name:
Other - Last Name:GARRIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSG
Mailing Address - Street 1:1148 NESHAMINY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1222
Mailing Address - Country:US
Mailing Address - Phone:267-221-2172
Mailing Address - Fax:
Practice Address - Street 1:105 E PENNSYLVANIA BLVD
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7843
Practice Address - Country:US
Practice Address - Phone:267-221-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG015017225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMSG015017OtherSTATE