Provider Demographics
NPI:1073765723
Name:RIDDOCK, CARRIE (LPT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:RIDDOCK
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 KLINE CT
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-3238
Mailing Address - Country:US
Mailing Address - Phone:804-556-0147
Mailing Address - Fax:
Practice Address - Street 1:813 KLINE CT
Practice Address - Street 2:
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-3238
Practice Address - Country:US
Practice Address - Phone:804-556-0147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist