Provider Demographics
NPI:1679615728
Name:RICHARDSON, JAMES KERRY (RPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KERRY
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7088 UNIVERSITY CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-6992
Mailing Address - Country:US
Mailing Address - Phone:334-396-1400
Mailing Address - Fax:334-396-2727
Practice Address - Street 1:230 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592-5251
Practice Address - Country:US
Practice Address - Phone:205-695-5111
Practice Address - Fax:205-695-5110
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH 2757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051524507OtherBLUE CROSS PROVIDER #
AL51048213OtherBC/BS PROVIDER NUMBER
AL51048213OtherBC/BS PROVIDER NUMBER
AL51048213OtherBC/BS PROVIDER NUMBER
AL051524507Medicare ID - Type UnspecifiedPROVIDER NUMBER