Provider Demographics
NPI:1255658415
Name:RICHARDS, ROSALYN ANNE (PT)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:ANNE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROSALYN
Other - Middle Name:ANNE
Other - Last Name:NORMAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:484 S LITTLE BEAR TRAIL
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-8536
Mailing Address - Country:US
Mailing Address - Phone:520-559-4498
Mailing Address - Fax:
Practice Address - Street 1:484 S LITTLE BEAR TRAIL
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-8536
Practice Address - Country:US
Practice Address - Phone:520-559-4498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPT#3416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist