Provider Demographics
NPI:1760455836
Name:RICHARDSON, SAMUEL WESLEY (MAED, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:WESLEY
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MAED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 CAMDEN CV. W.
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2346
Mailing Address - Country:US
Mailing Address - Phone:256-389-9029
Mailing Address - Fax:
Practice Address - Street 1:401 COX BLVD
Practice Address - Street 2:UNIT E
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-4058
Practice Address - Country:US
Practice Address - Phone:256-246-3490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer