Provider Demographics
NPI:1356667364
Name:RIEDL, DEVENA D (LMT)
Entity Type:Individual
Prefix:
First Name:DEVENA
Middle Name:D
Last Name:RIEDL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14417 S 41ST WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6152
Mailing Address - Country:US
Mailing Address - Phone:602-318-4901
Mailing Address - Fax:
Practice Address - Street 1:1840 E WARNER RD
Practice Address - Street 2:SUITE 128
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3437
Practice Address - Country:US
Practice Address - Phone:602-318-4901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-00208P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist