Provider Demographics
NPI:1689067282
Name:ANCELL, RICHARD (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:ANCELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8857 DAVIS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-0308
Mailing Address - Country:US
Mailing Address - Phone:817-431-8700
Mailing Address - Fax:
Practice Address - Street 1:8857 DAVIS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-0308
Practice Address - Country:US
Practice Address - Phone:817-431-8700
Practice Address - Fax:817-431-8811
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-06
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1116184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3460644-01Medicaid