Active NPI
Jeffrey D Richardson, P.T.
- Physical Therapist
- San Carlos, AZ
National Provider Identifier
1356453278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5040 PT
- Practice address
- 223 Cibeque Circle Road
San Carlos, AZ 85550-0208 - Phone
- (928) 475-7219
- Fax
- (928) 475-7370
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 5040 PT | AZ | Primary |
Addresses
Primary practice location
223 Cibeque Circle Road
San Carlos, AZ 85550-0208
Mailing address
PO Box 208
San Carlos, AZ 85550-0208
Phone (928) 475-7219
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 482729 | Medicaid | AZ |
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 |
|---|---|---|---|
| 5040 | AZ | MD | Diagnostic Radiology Physician |
| 5040 PT | AZ | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1356453278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 208",
"city": "SAN CARLOS",
"state": "AZ",
"postal_code": "855500208",
"telephone_number": "928-475-7219",
"fax_number": "928-475-7370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "223 CIBEQUE CIRCLE ROAD",
"city": "SAN CARLOS",
"state": "AZ",
"postal_code": "855500208",
"telephone_number": "928-475-7219",
"fax_number": "928-475-7370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDSON",
"first_name": "JEFFREY",
"middle_name": "D",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "5040 PT",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "482729",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Carlos, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.