Basic Information
| Provider Information | |||||||||
| NPI: | 1447817564 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARDSON REHABILITATION SERVICES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 BROADWAY ST | ||||||||
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| City: | HOMEWOOD | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352095301 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3800 RIDGEWAY DR | ||||||||
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| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352095506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058682000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2019 | ||||||||
| LastUpdateDate: | 07/31/2019 | ||||||||
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| AuthorizedOfficialLastName: | RICHARDSON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | TYLER | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3347985583 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.