Provider Demographics
NPI:1841507191
Name:RICHMOND, DONNA (PT,CWS)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:PT,CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9265 S 225 E
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:IN
Mailing Address - Zip Code:47234-9747
Mailing Address - Country:US
Mailing Address - Phone:317-512-9439
Mailing Address - Fax:
Practice Address - Street 1:150 BEECHMONT DR
Practice Address - Street 2:HARRISON HEALTH AND REHABILITATION CENTER
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112
Practice Address - Country:US
Practice Address - Phone:812-738-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002213A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist