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General NPI Number Information
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NPI Number | 1104057413
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Entity Type | Individual
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Provider Name | RAY M. RICHMOND P.T.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 2900 FOXFIELD RD STE 205
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City | ST CHARLES
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State | IL
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Zip | 60174-5799
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Country | US
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Telephone | 630-797-4344
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Fax |
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Provider Business Mailing Address
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Address Line | 1505 MERIDIAN CT
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City | BARTLETT
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State | IL
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Zip | 60103-8966
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Country | US
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Telephone | 630-404-8691
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Fax |
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 070.005479
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License Number State | IL
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