Provider Demographics
NPI:1558162750
Name:RICHARDSON- WEBSTER, SHELISE ARLETTE (PT)
Entity type:Individual
Prefix:MRS
First Name:SHELISE
Middle Name:ARLETTE
Last Name:RICHARDSON- WEBSTER
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12513 SAFARI LN
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-0712
Mailing Address - Country:US
Mailing Address - Phone:813-356-8215
Mailing Address - Fax:
Practice Address - Street 1:910 COMPASSION CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1645
Practice Address - Country:US
Practice Address - Phone:907-212-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21803261QP2000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy