Provider Demographics
NPI:1124557798
Name:RIDEOUT, EMILY KAY (ATC)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:KAY
Last Name:RIDEOUT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10217 CORREE COVE DR
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-2133
Mailing Address - Country:US
Mailing Address - Phone:910-545-2076
Mailing Address - Fax:
Practice Address - Street 1:10217 CORREE COVE DR
Practice Address - Street 2:
Practice Address - City:EMERALD ISLE
Practice Address - State:NC
Practice Address - Zip Code:28594-2133
Practice Address - Country:US
Practice Address - Phone:910-545-2076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20000287252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer