Provider Demographics
NPI:1215585690
Name:RIDENHOUR, MAGGIE CHRISTINE (DPT)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:CHRISTINE
Last Name:RIDENHOUR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2631
Mailing Address - Country:US
Mailing Address - Phone:925-324-7273
Mailing Address - Fax:
Practice Address - Street 1:1541 OLD BAYSHORE HWY
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1602
Practice Address - Country:US
Practice Address - Phone:650-638-9142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2970182251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics