Provider Demographics
NPI:1134658107
Name:RIDEOUT, CLIFFORD FRANCIS III (PTA)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:FRANCIS
Last Name:RIDEOUT
Suffix:III
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2732
Mailing Address - Country:US
Mailing Address - Phone:978-578-2506
Mailing Address - Fax:
Practice Address - Street 1:11974 EDGEHILL TERRACE RD
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-2105
Practice Address - Country:US
Practice Address - Phone:401-651-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7845225100000X
MDA4671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist