Provider Demographics
NPI:1124691167
Name:RICHEY, RUSSELL H (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:H
Last Name:RICHEY
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10207 HIGH NOON DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-1956
Mailing Address - Country:US
Mailing Address - Phone:214-730-1271
Mailing Address - Fax:
Practice Address - Street 1:10207 HIGH NOON DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-1956
Practice Address - Country:US
Practice Address - Phone:214-730-1271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16037225700000X
TX110098225700000X
CA12794225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist