Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 813 | TX |
NPI | 1831102565 |
---|---|
Provider Name | Kim L Richardson |
First Address | Waco, TX 76712 |
Second Address | Waco, TX 76711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |