Provider Demographics
NPI:1336315514
Name:RICHARDSON, CHARLES WILLIAM II (LPTA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:RICHARDSON
Suffix:II
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:75 BRIMBAL AVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6009
Mailing Address - Country:US
Mailing Address - Phone:978-927-2020
Mailing Address - Fax:972-922-4643
Practice Address - Street 1:75 BRIMBAL AVE
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6009
Practice Address - Country:US
Practice Address - Phone:978-927-2020
Practice Address - Fax:972-922-4643
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2709225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant