Provider Demographics
NPI:1932237468
Name:RICHEY, NICHOLAS KEITH (ATC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:KEITH
Last Name:RICHEY
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 1:1042 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4803
Mailing Address - Country:US
Mailing Address - Phone:517-256-8960
Mailing Address - Fax:
Practice Address - Street 1:MEN'S BASKETBALL OFFICE
Practice Address - Street 2:534 BIRCH RD. SUITE 150
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-4882
Practice Address - Country:US
Practice Address - Phone:517-256-8960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010017872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer