Provider Demographics
NPI:1225257140
Name:RIDLER, DANETTE B (DOCTORATE OF PT)
Entity Type:Individual
Prefix:DR
First Name:DANETTE
Middle Name:B
Last Name:RIDLER
Suffix:
Gender:F
Credentials:DOCTORATE OF PT
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3405 SUMMERHILL DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7722
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5570 POWERS CENTER PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7100
Practice Address - Country:US
Practice Address - Phone:719-266-6022
Practice Address - Fax:719-277-7217
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO512634ZUPJMedicare PIN