Provider Demographics
NPI:1255469375
Name:RICHARDSON, BRIAN ALAN (PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALAN
Last Name:RICHARDSON
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 1:615 LAZELLE RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-9541
Mailing Address - Country:US
Mailing Address - Phone:843-364-6922
Mailing Address - Fax:
Practice Address - Street 1:156 GRANVILLE ST
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6505
Practice Address - Country:US
Practice Address - Phone:614-470-6240
Practice Address - Fax:614-470-6244
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist