MEDICARE: JAMES 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	PT000895	PA

General Provider Information

NPI Number	:	1215943840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES RICHARDSON PT

Provider Business Mailing Address
First Line	:	4499 HILTY RD
Second Line	:
City	:	MURRYSVILLE
State	:	PA
Zip	:	15668-9315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	169 COLUMBIA AVE
Second Line	:
City	:	VANDERGRIFT
State	:	PA
Zip	:	15690-1101
Country	:	US
Telephone Number	:	724-567-7100
Fax Number	:

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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