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Individual

ANGELA MARIE RICKABAUGH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
(803) 791-2000
Mailing address
470 HULON LANE, ATTN: VP OF REVENUE CYCLE, WEST COLUMBIA, SC 29169-4810
(803) 791-2000

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070012611
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01623654
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/19/2006
Last updated
10/28/2020
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