Provider Demographics
NPI:1528392792
Name:RICHARDSON, NATALIE (MPT)
Entity Type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12509 84TH RD
Mailing Address - Street 2:3
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2247
Mailing Address - Country:US
Mailing Address - Phone:646-251-7459
Mailing Address - Fax:
Practice Address - Street 1:12509 84TH RD
Practice Address - Street 2:3
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2247
Practice Address - Country:US
Practice Address - Phone:646-251-7459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021273-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist