Provider Demographics
NPI:1639316441
Name:RICHARDSON, RUZA VACEK (LMT, BA)
Entity Type:Individual
Prefix:MRS
First Name:RUZA
Middle Name:VACEK
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMT, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 58TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-1131
Mailing Address - Country:US
Mailing Address - Phone:727-515-9475
Mailing Address - Fax:
Practice Address - Street 1:3801 PARK ST N
Practice Address - Street 2:SUITE #2
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4078
Practice Address - Country:US
Practice Address - Phone:727-343-8783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13778225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist