MEDICARE: JILL CHRISTINE RICHARDSON

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	225400000X	Rehabilitation Practitioner
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1205031408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL CHRISTINE RICHARDSON

Provider Business Mailing Address
First Line	:	1800 PALACE DR
Second Line	:	SUITE C
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-6264
Country	:	US
Telephone Number	:	913-952-4905
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 PALACE DR
Second Line	:	SUITE C
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-6264
Country	:	US
Telephone Number	:	913-952-4905
Fax Number	:

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

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	08/25/2023

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