Provider Demographics
NPI:1417612227
Name:RICHARDSON, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5246 ONLEY RD
Mailing Address - Street 2:
Mailing Address - City:GIRDLETREE
Mailing Address - State:MD
Mailing Address - Zip Code:21829-2724
Mailing Address - Country:US
Mailing Address - Phone:410-422-2228
Mailing Address - Fax:
Practice Address - Street 1:430 W MARKET ST
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863-1127
Practice Address - Country:US
Practice Address - Phone:443-859-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5249225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant