MEDICARE: MICHAEL RICHARDSON PT

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	2305006589	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548279235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL RICHARDSON PT

Provider Business Mailing Address
First Line	:	20347 TIMBERLAKE RD
Second Line	:	STE B
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-7352
Country	:	US
Telephone Number	:	434-845-9053
Fax Number	:	434-528-2788

Provider Business Practice Location Address
First Line	:	1111 CORPORATE PARK DR
Second Line	:	STE B
City	:	FOREST
State	:	VA
Zip	:	24551-2286
Country	:	US
Telephone Number	:	434-525-4851
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	11/14/2016

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