Provider Demographics
NPI:1437258167
Name:RIDD, ROGER L (MPT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:L
Last Name:RIDD
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 CASTLEVALE RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-5603
Mailing Address - Country:US
Mailing Address - Phone:509-576-0100
Mailing Address - Fax:509-576-0101
Practice Address - Street 1:4205 CASTLEVALE RD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-5603
Practice Address - Country:US
Practice Address - Phone:509-576-0100
Practice Address - Fax:509-576-0101
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8350647OtherLABOR AND INDUSTRIES
WA8945507OtherCRIME VICTIMS
WA106263300OtherOFFICE OF WORKERS COMP