Healthcare Provider Details

I. General information

NPI: 1336270750
Provider Name (Legal Business Name): RICHELLE L RICHARDS P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GORE ST SUITE 300
ORLANDO FL
32806-1044
US

IV. Provider business mailing address

1000 NODDING PINES WAY
CASSELBERRY FL
32707-5913
US

V. Phone/Fax

Practice location:
  • Phone: 407-254-2558
  • Fax:
Mailing address:
  • Phone: 407-677-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 18465
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: