Provider Demographics
NPI:1285720219
Name:RICHMOND, ANNA MARIA C (PT)
Entity type:Individual
Prefix:
First Name:ANNA MARIA
Middle Name:C
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNA MARIA
Other - Middle Name:CAMBOR
Other - Last Name:MONTICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1505 MERIDIAN CT
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 FLETCHER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4703
Practice Address - Country:US
Practice Address - Phone:847-888-0663
Practice Address - Fax:847-888-2967
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4532127OtherBCBS
4532127OtherBCBS
ILL98082Medicare ID - Type Unspecified