Provider Demographics
NPI:1326163536
Name:RICHTER, JOAN (PT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:RICHTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 NORTHERN BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3004
Mailing Address - Country:US
Mailing Address - Phone:516-627-7436
Mailing Address - Fax:516-627-7469
Practice Address - Street 1:1350 NORTHERN BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3004
Practice Address - Country:US
Practice Address - Phone:516-627-7436
Practice Address - Fax:516-627-7469
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ53081Medicare ID - Type Unspecified