MEDICARE: PELLETIER RICKERT PHYSICAL THERAPY, INC., P.A.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255302824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELLETIER RICKERT PHYSICAL THERAPY, INC., P.A.

Provider Business Mailing 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

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	:	PT/OWNER
Name	:	MR. LAWRENCE R RICKERT
Credential	:	PT
Telephone Number	:	239-772-3335

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	08/22/2020

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