Provider Demographics
NPI:1831533637
Name:RICKETTS, CHRISTINA ELAINE (MAT, ATC, LAT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ELAINE
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-2599
Mailing Address - Country:US
Mailing Address - Phone:254-652-1172
Mailing Address - Fax:
Practice Address - Street 1:900 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-2599
Practice Address - Country:US
Practice Address - Phone:254-652-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT47792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1831533637OtherATHLETIC TRAINING