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General NPI Number Information
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NPI Number | 1033139274
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Entity Type | Individual
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Provider Name | BRENDA ELAINE RICHARDSON PT
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Gender | Female
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 3160 W BRITTON RD SUITE C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-2068
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Country | US
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Telephone | 405-751-9595
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Fax | 405-755-4045
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Provider Business Mailing Address
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Address Line | 3160 W BRITTON RD SUITE C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-2039
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Country | US
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Telephone | 405-751-9595
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Fax | 405-755-4045
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT1362
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License Number State | OK
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