Provider Demographics
NPI:1073740692
Name:MCPHEARSON, RICHARD DALE (DPT,MTC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:DALE
Last Name:MCPHEARSON
Suffix:
Gender:M
Credentials:DPT,MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-0280
Mailing Address - Country:US
Mailing Address - Phone:318-775-9870
Mailing Address - Fax:318-775-9884
Practice Address - Street 1:235 FAIRBURN AVE
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:LA
Practice Address - Zip Code:71006-4904
Practice Address - Country:US
Practice Address - Phone:318-935-9075
Practice Address - Fax:318-935-9076
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07547R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist