Provider Demographics
NPI:1164618062
Name:RICHMOND, BRETT CHRISTOPHER (PT)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:CHRISTOPHER
Last Name:RICHMOND
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 1:8525 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-3604
Mailing Address - Country:US
Mailing Address - Phone:402-339-1108
Mailing Address - Fax:402-339-2794
Practice Address - Street 1:8525 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-3604
Practice Address - Country:US
Practice Address - Phone:402-339-1108
Practice Address - Fax:402-339-2794
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2615Medicaid
NE099668014Medicare PIN
NE099668Medicare PIN