Provider Demographics
NPI:1710468970
Name:RARICK, RICHARD LOREN (PTA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LOREN
Last Name:RARICK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 S RED RIVER EXPY
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-3714
Mailing Address - Country:US
Mailing Address - Phone:940-569-9500
Mailing Address - Fax:940-569-9800
Practice Address - Street 1:1119 S RED RIVER EXPY
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-3714
Practice Address - Country:US
Practice Address - Phone:940-569-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2045581225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant