MEDICARE: SARA MARIE RIKER DPT

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	5501012753	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	65-0-G0-1435-0	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1104929488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA MARIE RIKER DPT

Provider Business Mailing Address
First Line	:	11960 LIONESS WAY
Second Line	:	STE 260
City	:	PARKER
State	:	CO
Zip	:	80134-5640
Country	:	US
Telephone Number	:	720-324-9380
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 HAMMOND RD E
Second Line	:	SUITE 5
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-9362
Country	:	US
Telephone Number	:	231-995-5210
Fax Number	:	231-995-5213

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

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	02/16/2021

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Directions to “ SARA MARIE RIKER DPT” Practice Location

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