Provider Demographics
NPI:1538495726
Name:RICHARDSON, NEELY DANIELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:NEELY
Middle Name:DANIELLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N. MAIN
Mailing Address - Street 2:JONES PHYSICAL THERAPY
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2214
Mailing Address - Country:US
Mailing Address - Phone:870-741-4500
Mailing Address - Fax:870-741-4507
Practice Address - Street 1:1425 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2214
Practice Address - Country:US
Practice Address - Phone:870-741-4500
Practice Address - Fax:870-741-4507
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140564721Medicaid