Provider Demographics
NPI:1699431171
Name:RICHARDSON, BREANA (DPT)
Entity type:Individual
Prefix:
First Name:BREANA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 GADSDEN HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-2666
Mailing Address - Country:US
Mailing Address - Phone:205-083-8115
Mailing Address - Fax:205-876-8063
Practice Address - Street 1:7040 GADSDEN HWY STE 100
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2666
Practice Address - Country:US
Practice Address - Phone:205-083-8115
Practice Address - Fax:205-876-8063
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist