Provider Demographics
NPI:1578618179
Name:RICHARDSON, ALICIA (MPT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:3101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1921
Mailing Address - Country:US
Mailing Address - Phone:816-841-2284
Mailing Address - Fax:816-753-7836
Practice Address - Street 1:3101 MAIN ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1921
Practice Address - Country:US
Practice Address - Phone:816-841-2284
Practice Address - Fax:816-753-7836
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004021781225100000X
KS11-03435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO488404005Medicaid
KS200301370AMedicaid