Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1073144184 |
---|---|
Provider Name | Rachael Richards |
First Address | Keytesville, MO 65261-2038 |
Second Address | Fruita, CO 81521-6305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2020 |
Last Update Date | 28/01/2020 |