Provider Demographics
NPI:1669250205
Name:FLORES, RICHARD RAYMOND (PT)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RAYMOND
Last Name:FLORES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 E TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7415
Mailing Address - Country:US
Mailing Address - Phone:626-710-8154
Mailing Address - Fax:
Practice Address - Street 1:3507 S MERCY RD STE 105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0441
Practice Address - Country:US
Practice Address - Phone:626-710-8154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332192081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine