Provider Demographics
NPI:1639122898
Name:RICHTER, PHILLIP DANIEL (ATC)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:DANIEL
Last Name:RICHTER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 OVERBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-1515
Mailing Address - Country:US
Mailing Address - Phone:856-327-6040
Mailing Address - Fax:
Practice Address - Street 1:200 WADE BLVD
Practice Address - Street 2:MILLVILLE HIGH SCHOOL
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332
Practice Address - Country:US
Practice Address - Phone:856-327-6040
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000769002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer