Provider Demographics
NPI:1922281278
Name:RICHARDSON, RUSSELL S (PHD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:S
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DIVISION OF GERIATRICS
Mailing Address - Street 2:UNIVERSITY OF UTAH SCHOOL OF MEDICINE, AB193 SOM
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-587-9103
Mailing Address - Fax:
Practice Address - Street 1:DIVISION OF GERIATRICS
Practice Address - Street 2:UNIVERSITY OF UTAH SCHOOL OF MEDICINE, AB193 SOM
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-587-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist