Healthcare Provider Details

I. General information

NPI: 1255845509
Provider Name (Legal Business Name): LUC RICHE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2017
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1859 VAN BUREN ST
HOLLYWOOD FL
33020-5127
US

IV. Provider business mailing address

1859 VAN BUREN ST FL 1
HOLLYWOOD FL
33020-5127
US

V. Phone/Fax

Practice location:
  • Phone: 954-920-9000
  • Fax:
Mailing address:
  • Phone: 954-920-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number042382-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number35428
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: