Active NPI
Glenn L. Richardson, PT
- Physical Therapist
- Rayville, LA
National Provider Identifier
1326032392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- LA 03589
- Practice address
- 160 Christian Dr
Box 834
Rayville, LA 71269-3645 - Phone
- (318) 728-4088
- Fax
- (318) 728-4124
- NPI assigned
- Sep 7, 2005
- Last updated
- Feb 17, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | LA 03589 | LA | Primary |
Addresses
Primary practice location
160 Christian Dr
Box 834
Rayville, LA 71269-3645
Mailing address
950 Highway 584
Rayville, LA 71269-4328
Phone (318) 728-8879
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1106135 | Medicaid | LA |
Other names 1
- Larry Richardson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3589 | LA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| LA 03589 | LA | MD | Physical Therapist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Occupational Therapist
- Rayville, LA
- NPI 1831173657
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297900800000",
"number": "1326032392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "950 HIGHWAY 584",
"city": "RAYVILLE",
"state": "LA",
"postal_code": "712694328",
"telephone_number": "318-728-8879",
"fax_number": "318-728-8879"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 CHRISTIAN DR",
"address_2": "BOX 834",
"city": "RAYVILLE",
"state": "LA",
"postal_code": "712693645",
"telephone_number": "318-728-4088",
"fax_number": "318-728-4124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDSON",
"first_name": "GLENN",
"middle_name": "L.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-07",
"last_updated": "2011-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "LA 03589",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1106135",
"state": "LA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LARRY",
"last_name": "RICHARDSON",
"credential": "PT",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Rayville, LA
- Walter Anthony Regana
- Holly Reichardt, NP
- Richardson Dialysis, LLC (Richardson Dialysis)
- Richardson Medical Center Homecare
- Richardson Medical Center School Based Health Clinic
- Richland Homecare, L.L.C.
- Richland Hospital Service Distict #1-B (Richardson Medical Center)
- Richland Hospital Service District #1-B (Richardson Medical Center)
- Richland Hospital Service District #1-B (Richardson Medical Center)
- Richland Medical Group, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.