Provider Demographics
NPI:1205031408
Name:RICHARDSON, JILL CHRISTINE
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CHRISTINE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PALACE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6264
Mailing Address - Country:US
Mailing Address - Phone:913-952-4905
Mailing Address - Fax:
Practice Address - Street 1:1800 PALACE DR
Practice Address - Street 2:SUITE C
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6264
Practice Address - Country:US
Practice Address - Phone:913-952-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner