Provider Demographics
NPI:1649448630
Name:MCPHERSON, RICHARD (ATC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MCPHERSON
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:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN SYDNEY
Mailing Address - State:VA
Mailing Address - Zip Code:23943-0698
Mailing Address - Country:US
Mailing Address - Phone:434-223-6257
Mailing Address - Fax:
Practice Address - Street 1:1 KIRBY FIELDHOUSE DR
Practice Address - Street 2:
Practice Address - City:HAMPDEN-SYDNEY
Practice Address - State:VA
Practice Address - Zip Code:23943
Practice Address - Country:US
Practice Address - Phone:434-223-6257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260008092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer