MEDICARE: LAUREN RICCARDI PT, DPT, OCS, MBA

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	PT41781	FL
2	225100000X	Physical Therapist	PTL23922	MA

General Provider Information

NPI Number	:	1740727452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN RICCARDI PT, DPT, OCS, MBA

Provider Business Mailing Address
First Line	:	11190 HEALTH PARK BLVD BLDG 2
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34110-5729
Country	:	US
Telephone Number	:	239-572-3881
Fax Number	:	239-456-0531

Provider Business Practice Location Address
First Line	:	11190 HEALTH PARK BLVD BLDG 2
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34110-5729
Country	:	US
Telephone Number	:	239-572-3881
Fax Number	:	239-456-0531

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

Provider Enumeration Date	:	01/20/2017
Last Update Date	:	03/06/2026

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