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General NPI Number Information
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NPI Number | 1609572668
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Entity Type | Individual
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Provider Name | TAYLOR LEE RITCHERSON
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Gender | Female
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 232 BENS TRL
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City | FORT WORTH
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State | TX
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Zip | 76120-7000
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Country | US
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Telephone | 817-654-9010
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Fax |
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Provider Business Mailing Address
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Address Line | 11705 BUCKTHORN DR
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City | FORT WORTH
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State | TX
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Zip | 76108-2153
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Country | US
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Telephone | 806-673-9867
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2114492
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License Number State | TX
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