Provider Demographics
NPI:1720235054
Name:BELL, RICHARD ADAM (DPT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ADAM
Last Name:BELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-4232
Mailing Address - Country:US
Mailing Address - Phone:601-939-3030
Mailing Address - Fax:601-939-3042
Practice Address - Street 1:3825 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4232
Practice Address - Country:US
Practice Address - Phone:769-777-4400
Practice Address - Fax:769-777-4401
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09920015Medicaid
MS302I652336OtherMEDICARE PTAN