Provider Demographics
NPI:1649491176
Name:RICO, MIGUEL A (MSPT)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:RICO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:A
Other - Last Name:RICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:19008 W 97TH TERR.
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220
Mailing Address - Country:US
Mailing Address - Phone:913-768-1546
Mailing Address - Fax:
Practice Address - Street 1:325 MAINE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044
Practice Address - Country:US
Practice Address - Phone:785-840-2712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist