1891983342 NPI number — LORI M RICHARDSON PT

Table of content: LORI M RICHARDSON PT (NPI 1891983342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891983342 NPI number — LORI M RICHARDSON PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDSON
Provider First Name:
LORI
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891983342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103400 OVERSEAS HWY
Provider Second Line Business Mailing Address:
SUITE 111
Provider Business Mailing Address City Name:
KEY LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33037-2834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-785-4776
Provider Business Mailing Address Fax Number:
954-785-9789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103400 OVERSEAS HWY
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
KEY LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33037-2834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-785-4776
Provider Business Practice Location Address Fax Number:
954-785-9789
Provider Enumeration Date:
10/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT3855 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6607106 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y916B . This is a "BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7559289 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".