Provider Demographics
NPI:1750501649
Name:LIMEHOUSE, RICHARD ROBERTS JR (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ROBERTS
Last Name:LIMEHOUSE
Suffix:JR
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 1:67 OLD CHEROKEE WAY
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-8626
Mailing Address - Country:US
Mailing Address - Phone:706-867-5195
Mailing Address - Fax:
Practice Address - Street 1:67 OLD CHEROKEE WAY
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-8626
Practice Address - Country:US
Practice Address - Phone:706-867-5195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14832225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist