Provider Demographics
NPI:1225923972
Name:RICHARDSON, CONSETA (LMT,MMP)
Entity type:Individual
Prefix:
First Name:CONSETA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 SPRUCE POINT DR APT 1091
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-6072
Mailing Address - Country:US
Mailing Address - Phone:682-399-2659
Mailing Address - Fax:
Practice Address - Street 1:737 HIGHWAY 287 N STE 100
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2723
Practice Address - Country:US
Practice Address - Phone:817-908-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT139352225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist