Provider Demographics
NPI:1013456136
Name:RICHTMEYER, BRENDA L
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:RICHTMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CALEF ST
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4345
Mailing Address - Country:US
Mailing Address - Phone:401-258-6444
Mailing Address - Fax:
Practice Address - Street 1:12 CALEF ST
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4345
Practice Address - Country:US
Practice Address - Phone:401-258-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00544225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist