Provider Demographics
NPI:1659083459
Name:RICHARDSON, PEYTON LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PEYTON
Middle Name:LYNN
Last Name:RICHARDSON
Suffix:
Gender:F
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 1:2580 JUDGE FRAN JAMIESON WAY UNIT 3120
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6241
Mailing Address - Country:US
Mailing Address - Phone:512-903-1884
Mailing Address - Fax:
Practice Address - Street 1:4270 MINTON RD STE 120
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-9579
Practice Address - Country:US
Practice Address - Phone:321-984-2933
Practice Address - Fax:321-419-0334
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist