Provider Demographics
NPI:1649295817
Name:RICKERT, CHRISTINA H (DPT)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:H
Last Name:RICKERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WEXFORD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-4022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:624 E MAIN ST
Practice Address - Street 2:LACREST FITNESS CENTER
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2964
Practice Address - Country:US
Practice Address - Phone:215-368-7486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2300825000OtherBLUE CROSS HMO (KEYSTONE)
PA2300825000OtherBLUE CROSS HMO (KEYSTONE)