MEDICARE: MISS GINA L RICHARDSON DPT

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	034271	NY

General Provider Information

NPI Number	:	1154607703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GINA L RICHARDSON DPT

Provider Business Mailing Address
First Line	:	1818 NEWKIRK AVE
Second Line	:	LOBBY D
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7359
Country	:	US
Telephone Number	:	718-404-2539
Fax Number	:	718-421-5391

Provider Business Practice Location Address
First Line	:	1818 NEWKIRK AVE
Second Line	:	LOBBY D
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7359
Country	:	US
Telephone Number	:	718-404-2539
Fax Number	:	718-421-5391

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

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/27/2011

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