Individual
JOHNATHAN CICCHESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1747 BEAM AVE, SUITE NUMBER 100, MAPLEWOOD, MN 55109-1128
(651) 326-5569
Mailing address
2029 HENRY ST N, NORTH SAINT PAUL, MN 55109-4114
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10069
MN
Other
Enumeration date
08/28/2015
Last updated
08/28/2015
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