Provider Demographics
NPI:1003213455
Name:RICHARDSON, ALYSSIA (LMT)
Entity Type:Individual
Prefix:
First Name:ALYSSIA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16723 E ITHACA PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2814
Mailing Address - Country:US
Mailing Address - Phone:720-232-0898
Mailing Address - Fax:
Practice Address - Street 1:16723 E ITHACA PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-2814
Practice Address - Country:US
Practice Address - Phone:720-232-0898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0016933174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist