MEDICARE: MR. BRIAN IAN RICHMAN MPT

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	2305006244	VA

General Provider Information

NPI Number	:	1811927817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN IAN RICHMAN MPT

Provider Business Mailing Address
First Line	:	110 VISTA CENTRE DR STE 8
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-2600
Country	:	US
Telephone Number	:	434-385-4900
Fax Number	:	434-385-7100

Provider Business Practice Location Address
First Line	:	110 VISTA CENTRE DR STE 8
Second Line	:
City	:	FOREST
State	:	VA
Zip	:	24551-2600
Country	:	US
Telephone Number	:	434-385-4900
Fax Number	:	434-385-7100

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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