Provider Demographics
NPI:1700284940
Name:RICHARDSON, LINDA SMITH (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SMITH
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1361
Mailing Address - Country:US
Mailing Address - Phone:931-836-2713
Mailing Address - Fax:931-836-2843
Practice Address - Street 1:456 VISTA DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1361
Practice Address - Country:US
Practice Address - Phone:931-836-2713
Practice Address - Fax:931-836-2843
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000000168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist