Healthcare Provider Details

I. General information

NPI: 1326163536
Provider Name (Legal Business Name): JOAN RICHTER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 NORTHERN BLVD SUITE C
MANHASSET NY
11030-3004
US

IV. Provider business mailing address

1350 NORTHERN BLVD SUITE C
MANHASSET NY
11030-3004
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-7436
  • Fax: 516-627-7469
Mailing address:
  • Phone: 516-627-7436
  • Fax: 516-627-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002016
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: