Individual
MARY RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
211 WOOD RIDGE LN, LOWGAP, NC 27024-8909
(336) 352-3419
Mailing address
211 WOOD RIDGE LN, LOWGAP, NC 27024-8909
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4800
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4800
225200000X
NC
Enumeration date
04/14/2013
Last updated
04/14/2013
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