Provider Demographics
NPI:1427230564
Name:RIKKEN, DENNIS JOHANNES (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JOHANNES
Last Name:RIKKEN
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 1:411 HALLCREST TER
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-3730
Mailing Address - Country:US
Mailing Address - Phone:941-661-4082
Mailing Address - Fax:
Practice Address - Street 1:411 HALLCREST TER
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-3730
Practice Address - Country:US
Practice Address - Phone:941-661-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT8175OtherSTATE LICENSE NUMBER