Richard Gepford, PT
Individual provider Active NPI Specialist · Portola, CA
NPI 1114079035 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1114079035
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- PT8191 (CA)
- Practice address
- 73795 S Delleker Rd
Portola, CA 96122-6402 - Phone
- (530) 832-1701
- NPI assigned
- Jan 18, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT8191 | CA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sands Traveler PT, Inc. | Specialist | Past | Accepting new patients |
| Sands Traveler P.T. | Past | Accepting new patients | |
| Sands Travelers PT, Inc. | Specialist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | PT8191 | CA | Yes |
Addresses
Primary practice location
73795 S Delleker Rd
Portola, CA 96122-6402
Mailing address
73795 S Delleker Rd
Portola, CA 96122-6402
Phone (530) 832-1701
Other providers in Portola, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.