Provider Demographics
NPI:1801020748
Name:RICHARDSON, JOY A (PTA)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3457
Mailing Address - Street 2:
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-3457
Mailing Address - Country:US
Mailing Address - Phone:480-595-2184
Mailing Address - Fax:480-595-0212
Practice Address - Street 1:12600 N 113TH AVE BLDG A
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1162
Practice Address - Country:US
Practice Address - Phone:623-972-4033
Practice Address - Fax:623-972-4284
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0088A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant