Healthcare Provider Details

I. General information

NPI: 1578558029
Provider Name (Legal Business Name): KAREN L RICHARDSON PHYSICAL THERAPIST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E ZAVALA ST STE 1
CRYSTAL CITY TX
78839-3337
US

IV. Provider business mailing address

5911 PIONEER EST
SAN ANTONIO TX
78245-9602
US

V. Phone/Fax

Practice location:
  • Phone: 830-374-0537
  • Fax: 830-374-0538
Mailing address:
  • Phone: 830-374-0537
  • Fax: 830-374-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1010320
License Number StateTX

VIII. Authorized Official

Name: KAREN LOUISE RICHARDSON
Title or Position: OWNER THERAPIST IN CHARGE
Credential: LPT
Phone: 830-374-0539