MEDICARE: KAREN LOUISE RICHARDSON PT

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8129B9	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1912196122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LOUISE RICHARDSON PT

Provider Business Mailing Address
First Line	:	5911 PIONEER EST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-9602
Country	:	US
Telephone Number	:	830-985-3060
Fax Number	:	830-985-9193

Provider Business Practice Location Address
First Line	:	402 E ZAVALA ST
Second Line	:	SUITE 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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	10/24/2007

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