Provider Demographics
NPI:1093786659
Name:RICKERT, LAWRENCE P (PT)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:P
Last Name:RICKERT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 PANASOFFKEE DR
Mailing Address - Street 2:
Mailing Address - City:N FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-4755
Mailing Address - Country:US
Mailing Address - Phone:239-691-3121
Mailing Address - Fax:
Practice Address - Street 1:1240 SE 8TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3210
Practice Address - Country:US
Practice Address - Phone:239-772-3335
Practice Address - Fax:239-772-9267
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2806ZMedicare ID - Type Unspecified