Provider Demographics
NPI:1326369364
Name:RIDER PHYSICAL THERAPY & SPORTS CLINIC, INC.
Entity Type:Organization
Organization Name:RIDER PHYSICAL THERAPY & SPORTS CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:808-826-7433
Mailing Address - Street 1:4345 KUKE ST
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5310
Mailing Address - Country:US
Mailing Address - Phone:808-826-7433
Mailing Address - Fax:808-826-7437
Practice Address - Street 1:5161 KUHIO HWY.
Practice Address - Street 2:SUITE E 202
Practice Address - City:HANALEI
Practice Address - State:HI
Practice Address - Zip Code:96714-0000
Practice Address - Country:US
Practice Address - Phone:808-826-7433
Practice Address - Fax:808-826-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy