Individual
BRAD CICCOLELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, MPT, OCS
Contact information
Practice address
3053 NEW GERMANY RD, EBENSBURG, PA 15931-3516
(800) 332-5740
Mailing address
3053 NEW GERMANY RD, EBENSBURG, PA 15931-3516
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
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