Provider Demographics
NPI:1194556233
Name:RICCIUTI, CHRISTINA (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:RICCIUTI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 MYLANDER LN APT 3410
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2114
Mailing Address - Country:US
Mailing Address - Phone:240-743-9637
Mailing Address - Fax:
Practice Address - Street 1:1840 YORK RD STE G
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5121
Practice Address - Country:US
Practice Address - Phone:240-743-9637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM06444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist