Provider Demographics
NPI:1275847352
Name:RICHARDS, ROBERT A (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
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 1:10 LIBERTY SQ
Mailing Address - Street 2:BSMT 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-5814
Mailing Address - Country:US
Mailing Address - Phone:617-536-1161
Mailing Address - Fax:857-239-9711
Practice Address - Street 1:100 LINDSEY LN
Practice Address - Street 2:SUITE A
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6850
Practice Address - Country:US
Practice Address - Phone:912-729-1333
Practice Address - Fax:912-729-5259
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist