Provider Demographics
NPI:1073237103
Name:RICCA, MICHAEL ANGELO
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANGELO
Last Name:RICCA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:WILLIAM
Other - Last Name:LINTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2809 BOSTON ST APT 338
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4849
Mailing Address - Country:US
Mailing Address - Phone:410-236-6691
Mailing Address - Fax:
Practice Address - Street 1:3901 NATIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1176
Practice Address - Country:US
Practice Address - Phone:301-421-1125
Practice Address - Fax:301-500-2175
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program