Individual
GLENN L. RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
160 CHRISTIAN DR, BOX 834, RAYVILLE, LA 71269-3645
(318) 728-4088
(318) 728-4124
Mailing address
950 HIGHWAY 584, RAYVILLE, LA 71269-4328
(318) 728-8879
(318) 728-8879
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
LA 03589
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1106135
—
LA
Enumeration date
09/07/2005
Last updated
02/17/2011
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