Healthcare Provider Details

I. General information

NPI: 1558162750
Provider Name (Legal Business Name): SHELISE ARLETTE RICHARDSON- WEBSTER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 COOL ST
WATERVILLE ME
04901-5221
US

IV. Provider business mailing address

12513 SAFARI LN
RIVERVIEW FL
33579-0712
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-0721
  • Fax:
Mailing address:
  • Phone: 813-356-8215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number21803
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6854
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: