Provider Demographics
NPI:1659676336
Name:RICHARDSON, ADAM GEOFFREY (DPT)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:GEOFFREY
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:401 BAPTIST DR STE 306
Practice Address - Street 2:BAPTIST PT-MADISON
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-2012
Practice Address - Country:US
Practice Address - Phone:601-607-7204
Practice Address - Fax:601-607-7430
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0220392Medicaid
MS640881013OtherTAX ID
MS471307YJ5JMedicare PIN