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NPI Code Detail

MEDICARE: LYNDA-JEAN RICHARDSON PTA

MEDICARE: LYNDA-JEAN 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 AssistantPTA18097FL

General Provider Information

NPI Number : 1992117907
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNDA-JEAN RICHARDSON PTA
Provider Business Mailing Address
First Line : 700 S 29TH ST
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-3626
Country : US
Telephone Number : 772-465-7560
Fax Number : 772-465-5619
Provider Business Practice Location Address
First Line : 700 S 29TH ST
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-3626
Country : US
Telephone Number : 772-465-7560
Fax Number : 772-465-5619
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2014
Last Update Date : 05/25/2014

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