Provider Demographics
NPI:1972330348
Name:RICHARD, MARIA AISSA (RPT)
Entity type:Individual
Prefix:MRS
First Name:MARIA AISSA
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BOULEVARD PASTEUR
Mailing Address - Street 2:GALERIE JAUNE, PORTE H
Mailing Address - City:FRESNES
Mailing Address - State:ILE-DE-FRANCE
Mailing Address - Zip Code:94260
Mailing Address - Country:FR
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32 BOULEVARD PASTEUR
Practice Address - Street 2:GALERIE JAUNE, PORTE H
Practice Address - City:FRESNES
Practice Address - State:ILE-DE-FRANCE
Practice Address - Zip Code:94260
Practice Address - Country:FR
Practice Address - Phone:064-260-5370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist