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General NPI Number Information
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NPI Number | 1104621283
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Entity Type | Individual
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Provider Name | MENZISE J RICHARDSON
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Gender | Female
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 604 MID CITIES BLVD
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City | HURST
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State | TX
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Zip | 76054-2741
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Country | US
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Telephone | 682-426-3188
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Fax |
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Provider Business Mailing Address
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Address Line | 310 CREIGHTON AVE
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City | RED OAK
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State | TX
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Zip | 75154-1460
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Country | US
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Telephone | 901-218-1119
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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 | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 2279C0205X
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Taxonomy Name | Critical Care Registered Respiratory Therapist
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License Number | RCP02003936
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License Number State | TX
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