MEDICARE: CAROL RICHARDS ATC

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	174400000X	Specialist	AL1679	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AL1679	OTHER	FL	LICENSE NO.

General Provider Information

NPI Number	:	1558398289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL RICHARDS ATC

Provider Business Mailing Address
First Line	:	11149 MONARCH LANDING DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1529
Country	:	US
Telephone Number	:	904-710-2266
Fax Number	:

Provider Business Practice Location Address
First Line	:	12276 SAN JOSE BLVD
Second Line	:	SUITE 717
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8628
Country	:	US
Telephone Number	:	904-288-9604
Fax Number	:

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	10/27/2009

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Directions to “ CAROL RICHARDS ATC” Practice Location

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