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General NPI Number Information
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NPI Number | 1649196866
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Entity Type | Individual
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Provider Name | SOMERVILLE RICKER PT, DPT
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Gender |
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 362 CHRISTOPHER AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20879-3613
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Country | US
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Telephone | 240-410-3209
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Fax |
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Provider Business Mailing Address
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Address Line | 362 CHRISTOPHER AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20879-3613
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Country | US
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Telephone | 240-410-3209
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 30910
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License Number State | MD
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