Provider Demographics
NPI:1033541032
Name:RIDLER, JODI (PT DPT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:RIDLER
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:DAUBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BOX 8000 DEPT 314
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-213-0772
Mailing Address - Fax:716-324-5004
Practice Address - Street 1:350 GREENHAVEN TER
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-5547
Practice Address - Country:US
Practice Address - Phone:716-213-0772
Practice Address - Fax:716-213-0773
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05701419Medicaid