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General NPI Number Information
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NPI Number | 1477640894
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Entity Type | Individual
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Provider Name | MARISA LYNN RICKENBACH MSPT
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 20261 E OCOTILLO RD SUITE 110
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-8806
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Country | US
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Telephone | 480-677-2771
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Fax | 480-677-2768
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Provider Business Mailing Address
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Address Line | 4081 E SANTA FE LN
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City | GILBERT
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State | AZ
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Zip | 85297-8034
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Country | US
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Telephone | 480-656-4808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01208100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 7092
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT017984
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License Number State | PA
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