Provider Demographics
NPI:1053890830
Name:DELRICCIO, HAILEY MICHELLE (DPT)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:MICHELLE
Last Name:DELRICCIO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:MICHELLE
Other - Last Name:JAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9203 N ELM LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5364
Mailing Address - Country:US
Mailing Address - Phone:509-455-6002
Mailing Address - Fax:
Practice Address - Street 1:9911 N NEVADA ST STE A
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1298
Practice Address - Country:US
Practice Address - Phone:509-960-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60867210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist