Basic Information
| Provider Information | |||||||||
| NPI: | 1255469375 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 LAZELLE RD | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430819541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433646922 | ||||||||
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| Practice Location | |||||||||
| Address1: | 156 GRANVILLE ST | ||||||||
| Address2: | |||||||||
| City: | GAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432306505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144706240 | ||||||||
| FaxNumber: | 6144706244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.