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NPI Code Detail

MEDICARE: SARA RICKETT LMT

MEDICARE:   SARA  RICKETT  LMT
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
1225700000XMassage TherapistMT004133GA

General Provider Information

NPI Number : 1508493842
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA RICKETT LMT
Provider Business Mailing Address
First Line : 108 OOTHCALOOGA ST
Second Line :
City : CALHOUN
State : GA
Zip : 30701-2332
Country : US
Telephone Number : 706-383-6349
Fax Number :
Provider Business Practice Location Address
First Line : 108 OOTHCALOOGA ST
Second Line :
City : CALHOUN
State : GA
Zip : 30701-2332
Country : US
Telephone Number : 706-383-6349
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2020
Last Update Date : 03/26/2020

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Directions to “ SARA RICKETT LMT” Practice Location

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