Provider Demographics
NPI:1659730463
Name:RICKERT, JULIANNE
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:RICKERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:CAPPADONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 COMMERCE WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8200
Mailing Address - Country:US
Mailing Address - Phone:603-427-8066
Mailing Address - Fax:603-501-0495
Practice Address - Street 1:87 ELM ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1638
Practice Address - Country:US
Practice Address - Phone:508-544-1540
Practice Address - Fax:508-544-1541
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist