MEDICARE: SARA E RICHARDSON P.T.

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	2005031802	MO

General Provider Information

NPI Number	:	1316991367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA E RICHARDSON P.T.

Provider Business Mailing Address
First Line	:	605 E BOONESLICK RD
Second Line	:	SUITE 3
City	:	WARRENTON
State	:	MO
Zip	:	63383-2127
Country	:	US
Telephone Number	:	636-456-6350
Fax Number	:	636-456-6084

Provider Business Practice Location Address
First Line	:	605 E BOONESLICK RD
Second Line	:	SUITE 3
City	:	WARRENTON
State	:	MO
Zip	:	63383-2127
Country	:	US
Telephone Number	:	636-456-6350
Fax Number	:	636-456-6084

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	07/08/2007

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