Individual
DLISA RICHARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 GRAND PALMS DR, PEMBROKE PINES, FL 33027-1329
(305) 405-0400
Mailing address
16249 BISCAYNE BLVD, AVENTURA, FL 33160-4300
(305) 405-0400
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 22727
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
887989300
—
FL
Enumeration date
08/25/2011
Last updated
08/25/2011
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