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NPI Code Detail

MEDICARE: KEENA TISHELLE RICHARDSON PTA

MEDICARE: KEENA TISHELLE RICHARDSON PTA
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
1225200000XPhysical Therapy Assistant06006462AIN

General Provider Information

NPI Number : 1902543044
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEENA TISHELLE RICHARDSON PTA
Provider Business Mailing Address
First Line : 5515 W COUNTY ROAD 125 S
Second Line :
City : GREENCASTLE
State : IN
Zip : 46135-8360
Country : US
Telephone Number : 432-413-7386
Fax Number :
Provider Business Practice Location Address
First Line : 1140 INDIANAPOLIS RD
Second Line :
City : GREENCASTLE
State : IN
Zip : 46135-1458
Country : US
Telephone Number : 765-848-1421
Fax Number : 765-301-4351
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2022
Last Update Date : 05/19/2022

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Directions to “ KEENA TISHELLE RICHARDSON PTA” Practice Location

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