MEDICARE: BRANDON K RICHARDS 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	7620	ID
2	225100000X	Physical Therapist		NV

General Provider Information

NPI Number	:	1164715652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON K RICHARDS PT

Provider Business Mailing Address
First Line	:	904 WHITE AVE
Second Line	:
City	:	MOSCOW
State	:	ID
Zip	:	83843-3932
Country	:	US
Telephone Number	:	208-882-1426
Fax Number	:	208-882-1428

Provider Business Practice Location Address
First Line	:	4765 S DURANGO DR
Second Line	:	106
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8145
Country	:	US
Telephone Number	:	702-898-7633
Fax Number	:	702-898-6433

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

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	08/25/2021

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Directions to “ BRANDON K RICHARDS PT” Practice Location

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