Provider Demographics
NPI:1427167295
Name:RICKET, SANDY G (RRT)
Entity type:Individual
Prefix:MR
First Name:SANDY
Middle Name:G
Last Name:RICKET
Suffix:
Gender:M
Credentials:RRT
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Mailing Address - Street 1:NEMOURS CHILDREN&APOS S CLINIC
Mailing Address - Street 2:PO BOX 409992
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0001
Mailing Address - Country:US
Mailing Address - Phone:904-390-3610
Mailing Address - Fax:904-288-5890
Practice Address - Street 1:1717 S ORANGE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2944
Practice Address - Country:US
Practice Address - Phone:407-650-7000
Practice Address - Fax:407-650-7124
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLRT1021227900000X, 227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890293300Medicaid