Provider Demographics
NPI:1649848052
Name:RICHARDSON, ADRIANNA ROSE
Entity type:Individual
Prefix:MRS
First Name:ADRIANNA
Middle Name:ROSE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ADRIANNA
Other - Middle Name:ROSE
Other - Last Name:GARRITY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:814 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2943
Mailing Address - Country:US
Mailing Address - Phone:270-836-8918
Mailing Address - Fax:
Practice Address - Street 1:213 WATER ST
Practice Address - Street 2:
Practice Address - City:DAWSON SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42408-1727
Practice Address - Country:US
Practice Address - Phone:270-797-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA04123225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant