Provider Demographics
NPI:1922125822
Name:FREEDMAN, RICKIE
Entity Type:Individual
Prefix:
First Name:RICKIE
Middle Name:
Last Name:FREEDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 VILLA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-6702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17350 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:MILLMONT
Practice Address - State:PA
Practice Address - Zip Code:17845-9334
Practice Address - Country:US
Practice Address - Phone:570-922-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003482L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist