Provider Demographics
NPI:1588877757
Name:RICHARDSON PHYSICAL THERAPY CLINIC
Entity type:Organization
Organization Name:RICHARDSON PHYSICAL THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-235-3874
Mailing Address - Street 1:515 W CAMPBELL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3374
Mailing Address - Country:US
Mailing Address - Phone:972-235-3874
Mailing Address - Fax:972-235-9720
Practice Address - Street 1:515 W CAMPBELL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3374
Practice Address - Country:US
Practice Address - Phone:972-235-3874
Practice Address - Fax:972-235-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1031847261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0086JWOtherBLUE CROSS BLUE SHIELD
TX0086JWOtherBLUE CROSS BLUE SHIELD