Provider Demographics
NPI:1164935243
Name:RICHARDSON, BENNETT D (DPT)
Entity Type:Individual
Prefix:MR
First Name:BENNETT
Middle Name:D
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15144-1409
Mailing Address - Country:US
Mailing Address - Phone:724-275-7827
Mailing Address - Fax:724-275-7749
Practice Address - Street 1:507 PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:PA
Practice Address - Zip Code:15144-1409
Practice Address - Country:US
Practice Address - Phone:724-275-7827
Practice Address - Fax:724-275-7749
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0263402251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty