Provider Demographics
NPI:1578701637
Name:RICHARDSON, BETH E (DPT)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:E
Last Name:RICHARDSON
Suffix:
Gender:
Credentials:DPT
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:E
Other - Last Name:HENRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:42 AUDUBON ROAD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48370-2452
Mailing Address - Country:US
Mailing Address - Phone:248-909-2929
Mailing Address - Fax:
Practice Address - Street 1:45445 MOUND RD STE 109
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-5178
Practice Address - Country:US
Practice Address - Phone:248-297-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012963261QP2000X
MI550102963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy