Provider Demographics
NPI:1346125077
Name:RICHARDSON, ERIC (SPA OWNER)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:SPA OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 E COLONIAL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4726
Mailing Address - Country:US
Mailing Address - Phone:321-247-5553
Mailing Address - Fax:
Practice Address - Street 1:1516 E COLONIAL DR STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4726
Practice Address - Country:US
Practice Address - Phone:321-247-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist