Provider Demographics
NPI:1144260829
Name:RICKARDS, KATIE (PT)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:RICKARDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:26396 BAY FARM RD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4993
Practice Address - Country:US
Practice Address - Phone:302-947-9662
Practice Address - Fax:302-947-9692
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7909330OtherAETNA
DE1144260829Medicaid
DE3741922000OtherIBC
G02348D07OtherMEDICARE
000044069OtherDPCI
DEP00137273OtherRAILROAD MEDICARE
P00359638OtherRAILROAD MEDICARE
DE1144260829Medicaid
G02348D07OtherMEDICARE
P42898Medicare UPIN