Individual
NATHAN A RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
400 S STATION RD, GLEN CARBON, IL 62034-2743
(618) 288-5014
Mailing address
409 W WALL ST, MULBERRY GROVE, IL 62262-1017
(618) 339-3823
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.008987
IL
Other
Enumeration date
12/01/2021
Last updated
12/01/2021
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