Provider Demographics
NPI:1205847191
Name:ANDERSON, RICHARD P (MPT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 66TH ST
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-5030
Mailing Address - Country:US
Mailing Address - Phone:727-347-1286
Mailing Address - Fax:727-828-1474
Practice Address - Street 1:6500 66TH ST
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-5030
Practice Address - Country:US
Practice Address - Phone:727-347-1286
Practice Address - Fax:727-828-1474
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0E0UOtherBCBS OF FLORIDA
FLY0E0UOtherBCBS OF FLORIDA