Provider Demographics
NPI:1043388358
Name:COX, RICHARD RUSSELL (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:RUSSELL
Last Name:COX
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 DESCANSO WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356
Mailing Address - Country:US
Mailing Address - Phone:209-575-4127
Mailing Address - Fax:209-572-0132
Practice Address - Street 1:700 17TH ST
Practice Address - Street 2:STE 202
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1249
Practice Address - Country:US
Practice Address - Phone:209-572-4263
Practice Address - Fax:209-572-0132
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11937225100000X
ME3142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PT119370Medicare ID - Type Unspecified