Provider Demographics
NPI:1548713076
Name:RICKERT, PATRICK LAWRENCE (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LAWRENCE
Last Name:RICKERT
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 SE 8TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3210
Mailing Address - Country:US
Mailing Address - Phone:239-772-3335
Mailing Address - Fax:239-772-9267
Practice Address - Street 1:1240 SE 8TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3210
Practice Address - Country:US
Practice Address - Phone:239-772-3335
Practice Address - Fax:239-772-9267
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT31403OtherFLORIDA STATE LICENSE