Provider Demographics
NPI:1295007417
Name:RICHARD, ROBERT ROLAND II (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ROLAND
Last Name:RICHARD
Suffix:II
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 TERI CIR APT 141
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3983
Mailing Address - Country:US
Mailing Address - Phone:207-615-7120
Mailing Address - Fax:
Practice Address - Street 1:700 SACO RD
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6240
Practice Address - Country:US
Practice Address - Phone:207-648-7841
Practice Address - Fax:207-929-9147
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT3872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer