Provider Demographics
NPI:1114448495
Name:RICHARDSON, ZANE BRANNAN (PT,DPT,OCS)
Entity Type:Individual
Prefix:DR
First Name:ZANE
Middle Name:BRANNAN
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PT,DPT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 TALL TIMBERS
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75645-8327
Mailing Address - Country:US
Mailing Address - Phone:903-380-0072
Mailing Address - Fax:
Practice Address - Street 1:3133 GOOD SHEPHERD WAY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7921
Practice Address - Country:US
Practice Address - Phone:903-380-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1219022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist