Provider Demographics
NPI:1538535638
Name:RICHARDSON, CAUGHEY
Entity type:Individual
Prefix:
First Name:CAUGHEY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2427
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-1906
Mailing Address - Country:US
Mailing Address - Phone:830-997-2001
Mailing Address - Fax:830-997-0781
Practice Address - Street 1:1316 S STATE HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5058
Practice Address - Country:US
Practice Address - Phone:830-997-2001
Practice Address - Fax:830-997-0781
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1265080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349376901Medicaid
TX434573YU7HMedicare PIN