Basic Information
| Provider Information | |||||||||
| NPI: | 1316991367 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 605 E BOONESLICK RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | WARRENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633832127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6364566350 | ||||||||
| FaxNumber: | 6364566084 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 E BOONESLICK RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | WARRENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633832127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6364566350 | ||||||||
| FaxNumber: | 6364566084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2005031802 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.