Jennifer Renee Dicicco, DPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

P12753 Issued in NC

Practice address

4501 Cameron Valley Pkwy
Suite 300
Charlotte, NC 28211-4297

Phone

(703) 304-0620

Fax

(704) 304-0620

NPI assigned

Nov 3, 2008

Last updated

Nov 5, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jennifer Renee Manetti Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Baby Steps, LLC

  • Physical Therapy Clinic/Center
  • Charlotte, NC
  • NPI 1871182345
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352073600000",
    "number": "1255584330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035814",
            "telephone_number": "704-304-0620",
            "fax_number": "704-304-0621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 CAMERON VALLEY PKWY",
            "address_2": "SUITE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282114297",
            "telephone_number": "703-304-0620",
            "fax_number": "704-304-0620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICICCO",
        "first_name": "JENNIFER",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-03",
        "last_updated": "2012-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305205704",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NC",
            "license": "P12753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "MANETTI",
            "middle_name": "RENEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mrna Tracy Dibble, LCSW
• Kevin Dibella, D.C.
• Pamela Mechele Dicarlo
• Matthew J Dicerbo
• Maria Graziella Dichoso-Wood, MD
• Justin Dick, DC
• Kayla Dick
• Melissa J Dickard, IBCLC
• Dickens Group Home, LLC
• Courtney Dupree Dickens, LCMHCA

• Pediatric Physical Therapist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Pediatric Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.