Provider Demographics
NPI:1235149337
Name:RICHARDS, CLIFFORD JOHN (PT)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:JOHN
Last Name:RICHARDS
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 1:23870 SE KENT KANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6848
Mailing Address - Country:US
Mailing Address - Phone:425-432-1671
Mailing Address - Fax:425-432-1677
Practice Address - Street 1:23870 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6848
Practice Address - Country:US
Practice Address - Phone:425-432-1671
Practice Address - Fax:425-432-1677
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005147225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA609471200OtherOWCP DEPT. OF LABOR
WA0165RIOtherREGENCE
WA0191071OtherLABOR & INDUSTRIES
P00279139OtherRAILROAD MEDICARE
WA5147OtherWA STATE
P00279139OtherRAILROAD MEDICARE
WAG8850410Medicare UPIN