Provider Demographics
NPI:1558841700
Name:RICHARDSON, PARIS NICOLE (PT,DPT)
Entity type:Individual
Prefix:
First Name:PARIS
Middle Name:NICOLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 CRYSTAL ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-8814
Mailing Address - Country:US
Mailing Address - Phone:479-422-3692
Mailing Address - Fax:
Practice Address - Street 1:922 E EMMA AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4503
Practice Address - Country:US
Practice Address - Phone:479-770-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR45132251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics