Provider Demographics
NPI:1528065588
Name:RICHARDS PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:RICHARDS PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-916-2601
Mailing Address - Street 1:26471 CROWN VALLEY PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6378
Mailing Address - Country:US
Mailing Address - Phone:949-916-2601
Mailing Address - Fax:949-916-2302
Practice Address - Street 1:26471 CROWN VALLEY PKWY
Practice Address - Street 2:STE 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6378
Practice Address - Country:US
Practice Address - Phone:949-916-2601
Practice Address - Fax:949-916-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5808225100000X
CAW15939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15939Medicare PIN