Provider Demographics
NPI:1528889987
Name:RICHARDSON, THERESA (RDN, LDN)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 DREXEL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-3607
Mailing Address - Country:US
Mailing Address - Phone:267-394-3725
Mailing Address - Fax:
Practice Address - Street 1:507 DREXEL RD
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-3607
Practice Address - Country:US
Practice Address - Phone:267-394-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008736133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered