Provider Demographics
NPI:1033350970
Name:RICHARDSON, MICHAEL WILSON (CMT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WILSON
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:997 E COUNTY LINE RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1075
Mailing Address - Country:US
Mailing Address - Phone:317-881-8119
Mailing Address - Fax:317-881-8585
Practice Address - Street 1:997 E COUNTY LINE RD
Practice Address - Street 2:SUITE M
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1075
Practice Address - Country:US
Practice Address - Phone:317-881-8119
Practice Address - Fax:317-881-8585
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist