Provider Demographics
NPI:1235484197
Name:RICHMOND, FEGAN H (PT, DPT)
Entity type:Individual
Prefix:
First Name:FEGAN
Middle Name:H
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:FEGAN
Other - Middle Name:M
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:4831 S LABURNUM AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-2713
Practice Address - Country:US
Practice Address - Phone:804-222-0745
Practice Address - Fax:804-222-0748
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01406467OtherMEDICARE RR PTAN
VA1235484197Medicaid
VAC05954OtherMEDICARE GROUP PTAN
VAC05954OtherMEDICARE GROUP PTAN