Individual
MR. CHARLES TIMOTHY RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
506 4TH AVE W, BLDG 4, PALMETTO, FL 34221
(941) 729-1800
(941) 722-7844
Mailing address
PO BOX 820, PALMETTO, FL 34220
(941) 729-1800
(941) 722-7844
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT08788
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650016193
RAILROAD MEDICARE
—
01
—
Y900V
BLUE SHIELD
FL
Enumeration date
12/09/2005
Last updated
10/03/2011
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