Healthcare Provider Details

I. General information

NPI: 1093788655
Provider Name (Legal Business Name): HEIDI C RICHTER PA-C , AT-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 MYRTLE ST SUITE 160
ERIE PA
16502-4602
US

IV. Provider business mailing address

1910 SASSAFRAS ST STE 100
ERIE PA
16502-2716
US

V. Phone/Fax

Practice location:
  • Phone: 814-456-9197
  • Fax: 814-455-2765
Mailing address:
  • Phone: 814-456-9197
  • Fax: 814-455-2765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA051826
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT001481A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: