MEDICARE: RONALD THOMAS RICHARDSON PT, ATC

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	PTH261	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51537259	OTHER	AL	BLUE CROSS BLUE SHIELD AL
2	5224640	OTHER	AL	AETNA

General Provider Information

NPI Number	:	1972617389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD THOMAS RICHARDSON PT, ATC

Provider Business Mailing Address
First Line	:	725 OAKLINE CIR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35226-4110
Country	:	US
Telephone Number	:	205-515-0354
Fax Number	:

Provider Business Practice Location Address
First Line	:	3421 S SHADES CREST RD
Second Line	:	STE 107
City	:	HOOVER
State	:	AL
Zip	:	35244-3551
Country	:	US
Telephone Number	:	205-987-6501
Fax Number	:	205-987-6503

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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