Provider Demographics
NPI:1356077689
Name:ANDERSON-RIDENOUR, RACHEL SUSANNE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:SUSANNE
Last Name:ANDERSON-RIDENOUR
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 1:6180 OTTER RUN CT
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:VA
Mailing Address - Zip Code:20124-2337
Mailing Address - Country:US
Mailing Address - Phone:703-598-5472
Mailing Address - Fax:
Practice Address - Street 1:1760 OLD MEADOW RD STE 200
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4330
Practice Address - Country:US
Practice Address - Phone:703-988-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052151342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic