Provider Demographics
NPI:1912471285
Name:RICO, EASTER JOY (PT)
Entity Type:Individual
Prefix:MS
First Name:EASTER
Middle Name:JOY
Last Name:RICO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:EASTER JOY
Other - Middle Name:CAMPANA
Other - Last Name:RICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:286 TRAHAN RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-7769
Mailing Address - Country:US
Mailing Address - Phone:225-380-7287
Mailing Address - Fax:
Practice Address - Street 1:920 E AVENUE L
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-5014
Practice Address - Country:US
Practice Address - Phone:409-385-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1255771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist