Provider Demographics
NPI:1104929488
Name:RIKER, SARA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:RIKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11960 LIONESS WAY
Mailing Address - Street 2:STE 260
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5640
Mailing Address - Country:US
Mailing Address - Phone:720-324-9380
Mailing Address - Fax:
Practice Address - Street 1:1110 HAMMOND RD E
Practice Address - Street 2:SUITE 5
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-9362
Practice Address - Country:US
Practice Address - Phone:231-995-5210
Practice Address - Fax:231-995-5213
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI65-0-G0-1435-0OtherBCBS
MI65-0-G0-1435-0OtherBCBS
MIP04810013Medicare PIN
MI0P04810Medicare PIN