Provider Demographics
NPI:1689726119
Name:RICHARDS, JANICE R (PT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:R
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 W MACFARLANE RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49636-9716
Mailing Address - Country:US
Mailing Address - Phone:231-334-4456
Mailing Address - Fax:231-334-4456
Practice Address - Street 1:697 HANNAH ST SUITE A
Practice Address - Street 2:CENTER FOR INTEGRATIVE MEDICINE
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-947-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650D557010OtherBLUE CROSS BLUE SHIELD MI
MI650D557010OtherBLUE CROSS BLUE SHIELD MI