Individual
MRS. JENNIFER RENEE DICICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
4501 CAMERON VALLEY PKWY, SUITE 300, CHARLOTTE, NC 28211-4297
(703) 304-0620
(704) 304-0620
Mailing address
1100 BLYTHE BLVD, CHARLOTTE, NC 28203-5814
(704) 304-0620
(704) 304-0621
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2305205704
VA
2251P0200X
Pediatric Physical Therapist
Primary
P12753
NC
Other
Enumeration date
11/03/2008
Last updated
11/05/2012
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