Individual
BRAD CICCOLELLA
Active
Individual
BRAD CICCOLELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, MPT, OCS
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT018032
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101582673-0001
—
PA
01
—
1066644
WORKERS' COMP
WV
01
—
1845645
HIGHMARK
PA
Enumeration date
11/02/2006
Last updated
09/27/2007
Update your record
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