Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT 19049 | CA |
NPI | 1013080159 |
---|---|
Provider Name | Mary Beth Richardson |
First Address | Menlo Park, CA 94025-2628 |
Second Address | Redwood City, CA 94063-1715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 20/12/2021 |