Provider Demographics
NPI:1912069931
Name:RICKARD, CHARLES WALTER (PT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WALTER
Last Name:RICKARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MRS
Other - First Name:SHERRY
Other - Middle Name:C
Other - Last Name:RICKARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:221 HILLSBORO CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6201
Mailing Address - Country:US
Mailing Address - Phone:256-767-5254
Mailing Address - Fax:
Practice Address - Street 1:221 HILLSBORO CIR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6201
Practice Address - Country:US
Practice Address - Phone:256-767-5254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist