Provider Demographics
NPI:1841407434
Name:RICHARDSON, TRUDY T (P T)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:T
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BUMGARNER AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73026-3722
Mailing Address - Country:US
Mailing Address - Phone:405-321-2821
Mailing Address - Fax:
Practice Address - Street 1:5725 S ROSS AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-5650
Practice Address - Country:US
Practice Address - Phone:405-681-5787
Practice Address - Fax:405-681-5787
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist