Provider Demographics
NPI:1972617389
Name:RICHARDSON, RONALD THOMAS (PT, ATC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:THOMAS
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 OAKLINE CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-4110
Mailing Address - Country:US
Mailing Address - Phone:205-515-0354
Mailing Address - Fax:
Practice Address - Street 1:3421 S SHADES CREST RD
Practice Address - Street 2:STE 107
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3551
Practice Address - Country:US
Practice Address - Phone:205-987-6501
Practice Address - Fax:205-987-6503
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51537259OtherBLUE CROSS BLUE SHIELD AL
AL5224640OtherAETNA