MEDICARE: MOLLIE RICHARDSON PT, DPT

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	4331	AR
2	225100000X	Physical Therapist	CP048509T	NC

General Provider Information

NPI Number	:	1578054805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLIE RICHARDSON PT, DPT

Provider Business Mailing Address
First Line	:	4602 CUMBERLAND RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-2412
Country	:	US
Telephone Number	:	910-423-5622
Fax Number	:	910-378-1755

Provider Business Practice Location Address
First Line	:	5948 FISHER RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-5640
Country	:	US
Telephone Number	:	910-423-5622
Fax Number	:	910-378-1755

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

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	02/23/2026

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