Provider Demographics
NPI:1164677837
Name:RICHARDSON, GAIL D (LMT)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:D
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:D
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:3922 REGAL ROSE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2355
Mailing Address - Country:US
Mailing Address - Phone:210-332-3145
Mailing Address - Fax:210-265-1872
Practice Address - Street 1:3922 REGAL ROSE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2355
Practice Address - Country:US
Practice Address - Phone:210-332-3145
Practice Address - Fax:210-265-1872
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX039363225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist