Provider Demographics
NPI:1376540062
Name:GAUDIO, RICHARD B (PT, GCS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:B
Last Name:GAUDIO
Suffix:
Gender:M
Credentials:PT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 DELMAR LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-4745
Mailing Address - Country:US
Mailing Address - Phone:540-273-8000
Mailing Address - Fax:
Practice Address - Street 1:85 DELMAR LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-4745
Practice Address - Country:US
Practice Address - Phone:540-273-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050066172251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA012952F97Medicare PIN
P00465996Medicare PIN