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General NPI Number Information
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NPI Number | 1669805206
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Entity Type | Individual
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Provider Name | KIRK S RICHARDSON ATC
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Gender | Male
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 375 ROBERT M BELL PKWY
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City | AIKEN
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State | SC
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Zip | 29801-6385
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Country | US
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Telephone | 803-641-3628
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Fax | 803-641-3441
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Provider Business Mailing Address
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Address Line | 111 JOSHUA LN
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City | AIKEN
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State | SC
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Zip | 29801-1712
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Country | US
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Telephone | 540-309-6029
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Fax | 803-641-3441
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1086
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License Number State | SC
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