Provider Demographics
NPI:1548983430
Name:RICHARDSON, MARCUS ANTIONE (LAT, ATC, CPT)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:ANTIONE
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LAT, ATC, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1598 SAWMILL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-7640
Mailing Address - Country:US
Mailing Address - Phone:901-244-0643
Mailing Address - Fax:
Practice Address - Street 1:3992 CENTRAL CAMPUS DRIVE DEPT 3504
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-7640
Practice Address - Country:US
Practice Address - Phone:801-626-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy