Provider Demographics
NPI:1194847988
Name:BRENDA E. RICHARDSON, PT
Entity type:Organization
Organization Name:BRENDA E. RICHARDSON, PT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:G
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-751-9595
Mailing Address - Street 1:3140 W BRITTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2039
Mailing Address - Country:US
Mailing Address - Phone:405-751-9595
Mailing Address - Fax:405-755-4045
Practice Address - Street 1:3140 W BRITTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2039
Practice Address - Country:US
Practice Address - Phone:405-751-9595
Practice Address - Fax:405-755-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK442682224Medicare PIN