Provider Demographics
NPI:1477897775
Name:RICKARD, TAWANNA M (LPTA)
Entity Type:Individual
Prefix:
First Name:TAWANNA
Middle Name:M
Last Name:RICKARD
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-8912
Mailing Address - Country:US
Mailing Address - Phone:256-383-4541
Mailing Address - Fax:
Practice Address - Street 1:500 JOHN ALDRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-8912
Practice Address - Country:US
Practice Address - Phone:256-383-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1320225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant