Provider Demographics
NPI:1578299608
Name:RICHARD, PHILLIP (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:RICHARD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3713 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-4630
Mailing Address - Country:US
Mailing Address - Phone:409-330-4005
Mailing Address - Fax:409-330-4159
Practice Address - Street 1:3713 N 16TH ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77632-4630
Practice Address - Country:US
Practice Address - Phone:409-330-4005
Practice Address - Fax:409-330-4159
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1257979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist