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NPI Code Detail

MEDICARE: KENDRA RICHARDSON ATC, LAT

MEDICARE: KENDRA RICHARDSON ATC, LAT
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1902449234
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRA RICHARDSON ATC, LAT
Provider Business Mailing Address
First Line : 4541 S DALE MABRY HWY STE 200
Second Line :
City : TAMPA
State : FL
Zip : 33611-1407
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4541 S DALE MABRY HWY STE 200
Second Line :
City : TAMPA
State : FL
Zip : 33611-1407
Country : US
Telephone Number : 813-684-2663
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2019
Last Update Date : 10/18/2019

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Directions to “ KENDRA RICHARDSON ATC, LAT” Practice Location

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