Individual
MARK RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
333 TAMIAMI TRL S, VENICE, FL 34285-2402
(941) 484-2471
Mailing address
333 TAMIAMI TRL S, VENICE, FL 34285-2402
(941) 484-2471
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
25377
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25377
STATE PTA LISCENCE #PTA25377
FL
Enumeration date
01/30/2015
Last updated
01/30/2015
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