Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2305006617 | VA |
NPI | 1376540062 |
---|---|
Provider Name | Mr. Richard B Gaudio |
First Address | Fredericksburg, VA 22406-4745 |
Second Address | Fredericksburg, VA 22406-4745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 12/06/2012 |