| Doctor Name: | JOHNATHAN CICCHESE |
| NPI Number: | 1073980793 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPT |
| License Number: | 10069 |
| Business Practice Address: | 1747 Beam Ave Suite Number 100 Maplewood, MN - 551091128 |
| Business Phone Number: | 6513265569 |
| Business Fax Number: | |
| Mailing Address: | 2029 Henry St N, NORTH SAINT PAUL |
| State: | MN |
| Postal Code: | 551094114 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/28/2015 |
| NPI Last Update Date: | 08/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 10069 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |