Provider Demographics
NPI:1376908707
Name:RICHARDSON, DALINDA (PTA)
Entity Type:Individual
Prefix:
First Name:DALINDA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18200 E TENMILE ROAD
Mailing Address - Street 2:200
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021
Mailing Address - Country:US
Mailing Address - Phone:586-771-7500
Mailing Address - Fax:586-486-1700
Practice Address - Street 1:18200 E TENMILE ROAD
Practice Address - Street 2:200
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021
Practice Address - Country:US
Practice Address - Phone:586-771-7500
Practice Address - Fax:586-486-1700
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5502004767OtherMICHIGAN LICENSE