MEDICARE: RICHARD MAX SLADE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT021959	OH

General Provider Information

NPI Number	:	1164375747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD MAX SLADE PT

Provider Business Mailing Address
First Line	:	2039 COTTONWOOD CT
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4131
Country	:	US
Telephone Number	:	602-366-5732
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 YARD ST STE 300
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3882
Country	:	US
Telephone Number	:	614-866-8158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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