Provider Demographics
NPI:1063475556
Name:RICHARDSON, BETH (MHED PT OCS CHT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MHED PT OCS CHT
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT CHT MHED
Mailing Address - Street 1:771 PILOT HOUSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:9 MANHATTAN SQUARE
Practice Address - Street 2:STE B
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-825-3400
Practice Address - Fax:757-825-0392
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7302053OtherAETNA
VA192971OtherBCBS PHYSICAL THERAPY
VA8928665Medicaid
VAC05954Medicare PIN