Provider Demographics
NPI:1265719280
Name:RICK, JANESSA (PT)
Entity type:Individual
Prefix:
First Name:JANESSA
Middle Name:
Last Name:RICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GREENRIDGE AVE
Mailing Address - Street 2:APT 2M
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1240
Mailing Address - Country:US
Mailing Address - Phone:917-353-2412
Mailing Address - Fax:
Practice Address - Street 1:2 GREENRIDGE AVE
Practice Address - Street 2:APT 2M
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1240
Practice Address - Country:US
Practice Address - Phone:917-353-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110661-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist