MEDICARE: KEVIN J RICHARDSON 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	070012298	IL

General Provider Information

NPI Number	:	1174743967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN J RICHARDSON PT

Provider Business Mailing Address
First Line	:	600 OAKMONT LN STE 600C
Second Line	:
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	630-575-6250
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 N LASALLE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-0000
Country	:	US
Telephone Number	:	312-855-9206
Fax Number	:

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	10/16/2018

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Directions to “ KEVIN J RICHARDSON PT” Practice Location

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