MEDICARE: MOLLY RICHARDSON

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	225200000X	Physical Therapy Assistant	25411	FL

General Provider Information

NPI Number	:	1982321691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY RICHARDSON

Provider Business Mailing Address
First Line	:	2765 S BAY ST
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-6501
Country	:	US
Telephone Number	:	352-589-5595
Fax Number	:

Provider Business Practice Location Address
First Line	:	2765 S BAY ST
Second Line	:
City	:	EUSTIS
State	:	FL
Zip	:	32726-6501
Country	:	US
Telephone Number	:	352-589-5595
Fax Number	:

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

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

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Directions to “ MOLLY RICHARDSON ” Practice Location

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