MEDICARE: KAREN L RICHARDSON PHYSICAL THERAPIST PLLC

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	1010320	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0174721	OTHER	WA	DEPT OF LABOR AND INDUSTR
2	7080503	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1578558029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN L RICHARDSON PHYSICAL THERAPIST PLLC

Provider Business Mailing Address
First Line	:	5911 PIONEER EST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-9602
Country	:	US
Telephone Number	:	830-374-0537
Fax Number	:	830-374-0538

Provider Business Practice Location Address
First Line	:	402 E ZAVALA ST
Second Line	:	STE 1
City	:	CRYSTAL CITY
State	:	TX
Zip	:	78839-3337
Country	:	US
Telephone Number	:	830-374-0537
Fax Number	:	830-374-0538

Authorized Official
Title or Position	:	OWNER THERAPIST IN CHARGE
Name	:	KAREN LOUISE RICHARDSON
Credential	:	LPT
Telephone Number	:	830-374-0539

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	08/22/2020

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