Provider Demographics
NPI:1457591489
Name:RICCI, LAURA JANE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JANE
Last Name:RICCI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 HILLSIDE RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-7196
Mailing Address - Country:US
Mailing Address - Phone:806-355-7633
Mailing Address - Fax:806-355-7644
Practice Address - Street 1:6204 HILLSIDE RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-7196
Practice Address - Country:US
Practice Address - Phone:806-355-7633
Practice Address - Fax:806-355-7644
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1184310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist