MEDICARE: GINA ROSALIE RICKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225600000X	Dance Therapist	003165	NY

General Provider Information

NPI Number	:	1750223665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA ROSALIE RICKER

Provider Business Mailing Address
First Line	:	1612 MAIN ST UNIT 12
Second Line	:
City	:	PLEASANT VALLEY
State	:	NY
Zip	:	12569-7047
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1584 MAIN ST
Second Line	:
City	:	PLEASANT VALLEY
State	:	NY
Zip	:	12569-7818
Country	:	US
Telephone Number	:	347-338-0830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “ GINA ROSALIE RICKER ” Practice Location

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