Healthcare Provider Details

I. General information

NPI: 1518443811
Provider Name (Legal Business Name): SHEILA N. RICHARD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 S POWERLINE RD
POMPANO BEACH FL
33069-4300
US

IV. Provider business mailing address

1418 S POWERLINE RD
POMPANO BEACH FL
33069-4300
US

V. Phone/Fax

Practice location:
  • Phone: 954-975-0771
  • Fax: 954-975-0726
Mailing address:
  • Phone: 954-975-0771
  • Fax: 957-975-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: