Provider Demographics
NPI:1306362470
Name:RIDLEY, CHRISTINA YVONNE (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:YVONNE
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 BASS CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-1803
Mailing Address - Country:US
Mailing Address - Phone:408-802-2401
Mailing Address - Fax:
Practice Address - Street 1:6403 COYLE AVE STE 350
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0361
Practice Address - Country:US
Practice Address - Phone:916-536-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA293574OtherPHYSICAL THERAPY BOARD OF CALIFORNIA