Provider Demographics
NPI:1164071072
Name:RICHARDSON, ANDREW GEORGE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:GEORGE
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 EASTLAND DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6747
Mailing Address - Country:US
Mailing Address - Phone:208-736-9011
Mailing Address - Fax:
Practice Address - Street 1:421 WASHINGTON ST N
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4633
Practice Address - Country:US
Practice Address - Phone:208-735-9011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5171067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty