Healthcare Provider Details

I. General information

NPI: 1114890217
Provider Name (Legal Business Name): KIMBERLY LAUREN RICHARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 CORPORATE DR STE 245
IRVING TX
75038-7514
US

IV. Provider business mailing address

1004 TWIN CREEKS DR
ALLEN TX
75013-1190
US

V. Phone/Fax

Practice location:
  • Phone: 214-591-0061
  • Fax:
Mailing address:
  • Phone: 214-289-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number1147748
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: