Provider Demographics
NPI:1740404243
Name:GENZEL, RICHARD BRYAN (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRYAN
Last Name:GENZEL
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 1:2420 E RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-6335
Mailing Address - Country:US
Mailing Address - Phone:817-394-1010
Mailing Address - Fax:917-394-1017
Practice Address - Street 1:2420 E RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6335
Practice Address - Country:US
Practice Address - Phone:817-394-1010
Practice Address - Fax:917-394-1017
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist