Provider Demographics
NPI:1598132748
Name:RIDGE, RACHELLE LEANN (DPT)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:LEANN
Last Name:RIDGE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 COUNTY STREET 2780
Mailing Address - Street 2:
Mailing Address - City:MARLOW
Mailing Address - State:OK
Mailing Address - Zip Code:73055-6642
Mailing Address - Country:US
Mailing Address - Phone:580-380-9503
Mailing Address - Fax:
Practice Address - Street 1:4740 COUNTY STREET 2780
Practice Address - Street 2:
Practice Address - City:MARLOW
Practice Address - State:OK
Practice Address - Zip Code:73055-6642
Practice Address - Country:US
Practice Address - Phone:580-380-9503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7899225100000X
NC15880225100000X
OK5031225100000X
NY040055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist