Provider Demographics
NPI:1336938158
Name:RICAZA, ROMEDEL REPASO
Entity type:Individual
Prefix:
First Name:ROMEDEL
Middle Name:REPASO
Last Name:RICAZA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 MANHATTAN AVE, APT 4L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222
Mailing Address - Country:US
Mailing Address - Phone:347-829-3890
Mailing Address - Fax:
Practice Address - Street 1:727 MANHATTAN AVE, APT 4L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222
Practice Address - Country:US
Practice Address - Phone:347-829-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052706-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist