Provider Demographics
NPI:1295010502
Name:RICHARDSON, ROCHELLE RENEE (LMT)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:RENEE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 VICKERY LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0682
Mailing Address - Country:US
Mailing Address - Phone:901-751-9489
Mailing Address - Fax:901-751-9031
Practice Address - Street 1:1175 VICKERY LN
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0682
Practice Address - Country:US
Practice Address - Phone:901-751-9489
Practice Address - Fax:901-751-9031
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8501225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist