MEDICARE: MRS. KATELYN A RICHARD 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	15150	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	Y6874601	OTHER	MA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y67936	OTHER	MA	BCBS
2	468260	OTHER		TUFTS

General Provider Information

NPI Number	:	1659315646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATELYN A RICHARD PT

Provider Business Mailing Address
First Line	:	766 N KING ST
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-1142
Country	:	US
Telephone Number	:	413-785-1153
Fax Number	:	413-781-4951

Provider Business Practice Location Address
First Line	:	766 N KING ST
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-1142
Country	:	US
Telephone Number	:	413-586-0230
Fax Number	:	413-586-1068

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2015

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