Provider Demographics
NPI:1205838836
Name:HALFORD, RICHARD C (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:HALFORD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-9602
Mailing Address - Country:US
Mailing Address - Phone:828-712-1340
Mailing Address - Fax:844-262-1962
Practice Address - Street 1:113 RICHARDSON BLVD
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3526
Practice Address - Country:US
Practice Address - Phone:828-712-1340
Practice Address - Fax:844-262-1962
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP2207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211482Medicaid
NC7211482Medicaid