Provider Demographics
NPI:1518044171
Name:RIDER, THOMAS G (PT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:RIDER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W BYPASS
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-5255
Mailing Address - Country:US
Mailing Address - Phone:334-222-5785
Mailing Address - Fax:334-222-0181
Practice Address - Street 1:1105 W BYPASS
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5255
Practice Address - Country:US
Practice Address - Phone:334-222-5785
Practice Address - Fax:334-222-0181
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR62961Medicare UPIN
AL000073802Medicare ID - Type Unspecified