MEDICARE: MR. LAWRENCE P RICKERT PT

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	225100000X	Physical Therapist	PT3292	FL

General Provider Information

NPI Number	:	1093786659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE P RICKERT PT

Provider Business Mailing Address
First Line	:	12500 PANASOFFKEE DR
Second Line	:
City	:	N FORT MYERS
State	:	FL
Zip	:	33903-4755
Country	:	US
Telephone Number	:	239-691-3121
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 SE 8TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3210
Country	:	US
Telephone Number	:	239-772-3335
Fax Number	:	239-772-9267

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	01/18/2012

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