Provider Demographics
NPI:1194836007
Name:RICHARDSON, ROBERT TODD (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:TODD
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 THUNDER MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3424
Mailing Address - Country:US
Mailing Address - Phone:702-361-8311
Mailing Address - Fax:
Practice Address - Street 1:3600 LAS VEGAS BLVD S
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-4303
Practice Address - Country:US
Practice Address - Phone:702-693-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05061052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer