Provider Demographics
NPI:1679761936
Name:RICHARDS, ERICK DAVID (LMT)
Entity Type:Individual
Prefix:MR
First Name:ERICK
Middle Name:DAVID
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55531 BIG RIVER DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97707-2368
Mailing Address - Country:US
Mailing Address - Phone:541-550-6077
Mailing Address - Fax:
Practice Address - Street 1:1569 SW NANCY WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3234
Practice Address - Country:US
Practice Address - Phone:541-550-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist