Provider Demographics
NPI:1104621283
Name:RICHARDSON, MENZISE J
Entity type:Individual
Prefix:
First Name:MENZISE
Middle Name:J
Last Name:RICHARDSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CREIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-1460
Mailing Address - Country:US
Mailing Address - Phone:901-218-1119
Mailing Address - Fax:
Practice Address - Street 1:604 MID CITIES BLVD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2741
Practice Address - Country:US
Practice Address - Phone:682-426-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRCP020039362279C0205X
320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities