Doctor Name: | MR. RAY M. RICHMOND |
NPI Number: | 1104057413 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.T. |
License Number: | 070.005479 |
Business Practice Address: | 2900 Foxfield Rd Ste 205 St Charles, IL - 601745799 |
Business Phone Number: | 6307974344 |
Business Fax Number: | |
Mailing Address: | 1505 Meridian Ct, BARTLETT |
State: | IL |
Postal Code: | 601038966 |
Phone Number: | 6304048691 |
Fax Number: | |
NPI Enumeration Date: | 08/04/2009 |
NPI Last Update Date: | 08/04/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 070.005479 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |