Provider Demographics
NPI:1326147174
Name:RIDER, MIKE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:RIDER
Suffix:
Gender:M
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 1:417 N BENTON AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5041
Mailing Address - Country:US
Mailing Address - Phone:406-495-8995
Mailing Address - Fax:406-495-8996
Practice Address - Street 1:417 N BENTON AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5041
Practice Address - Country:US
Practice Address - Phone:406-495-8995
Practice Address - Fax:406-495-8996
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2011PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTPENDINGMedicare ID - Type UnspecifiedAPPLYING