Provider Demographics
NPI:1205275963
Name:RICHARDSON, DANIEL N (PT, DPT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:N
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 EDGEFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4214
Mailing Address - Country:US
Mailing Address - Phone:615-336-4989
Mailing Address - Fax:
Practice Address - Street 1:105 ROBINS WAY
Practice Address - Street 2:SUITE 201B
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-1129
Practice Address - Country:US
Practice Address - Phone:270-726-6640
Practice Address - Fax:270-726-6674
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist