Individual
LARCIE L RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
650 HENDERSON DR, CARTERSVILLE, GA 30120-3744
(678) 721-9922
Mailing address
PO BOX 242278, MONTGOMERY, AL 36124-2278
(334) 396-2110
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT009263
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT009263
PT LICENSE NUMBER
GA
Enumeration date
02/12/2008
Last updated
02/12/2008
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