Provider Demographics
NPI:1578558029
Name:KAREN L RICHARDSON PHYSICAL THERAPIST PLLC
Entity Type:Organization
Organization Name:KAREN L RICHARDSON PHYSICAL THERAPIST PLLC
Other - Org Name:KAREN L RICHARDSON PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER THERAPIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:830-374-0539
Mailing Address - Street 1:5911 PIONEER EST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-9602
Mailing Address - Country:US
Mailing Address - Phone:830-374-0537
Mailing Address - Fax:830-374-0538
Practice Address - Street 1:402 E ZAVALA ST
Practice Address - Street 2:STE 1
Practice Address - City:CRYSTAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78839-3337
Practice Address - Country:US
Practice Address - Phone:830-374-0537
Practice Address - Fax:830-374-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1010320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0174721OtherDEPT OF LABOR AND INDUSTR
TX7080503OtherAETNA
TX00948TMedicare ID - Type Unspecified
TX7080503OtherAETNA