Individual
PHILIP FANK DE RICCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
15-1841 LOKELANI AVE, KEAAU, HI 96749
(808) 315-3447
Mailing address
HC 2 BOX 6644, KEAAU, HI 96749-9310
(808) 315-3447
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
15944
HI
225700000X
Massage Therapist
8295
CT
Other
Enumeration date
11/07/2019
Last updated
04/30/2026
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