Provider Demographics
NPI:1255302824
Name:PELLETIER RICKERT PHYSICAL THERAPY, INC., P.A.
Entity Type:Organization
Organization Name:PELLETIER RICKERT PHYSICAL THERAPY, INC., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICKERT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:239-772-3335
Mailing Address - Street 1:1240 SE 8TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3210
Mailing Address - Country:US
Mailing Address - Phone:239-772-3335
Mailing Address - Fax:239-772-9267
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1139Medicare ID - Type Unspecified