Traci L Richardson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT016580 Issued in PA

Practice address

1146 Karen St
Boalsburg, PA 16827-1642

Phone

(814) 441-9183

Fax

(833) 277-6195

NPI assigned

Aug 3, 2005

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Positive Performance Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Boalsburg, PA
  • NPI 1619680105
  Medicare reassignment Authorized official
• Drayer Physical Therapy Institute LLC

  • Physical Therapist
  • Port Matilda, PA
  • NPI 1396136719
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672358400000",
    "number": "1972504769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 218",
            "city": "BOALSBURG",
            "state": "PA",
            "postal_code": "168270218",
            "telephone_number": "814-441-9183",
            "fax_number": "833-277-6195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1146 KAREN ST",
            "city": "BOALSBURG",
            "state": "PA",
            "postal_code": "168271642",
            "telephone_number": "814-441-9183",
            "fax_number": "833-277-6195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "TRACI",
        "middle_name": "L",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-03",
        "last_updated": "2022-12-30",
        "certification_date": "2021-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT016580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011155610005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olive Tree Counseling
• Nicole Pautz
• Positive Performance Physical Therapy LLC
• Linda K Puder, LMT
• Andrea Lynn Reed, RDN
• Schmidt Chiropractic
• Sharon A Schott, LPC, CRC
• Shephard Associates LLC
• Maggie Sopic, DC
• Debbie Ann Stachowski

• Physical Therapist in Boalsburg, PA
• Providers in Boalsburg, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.