Provider Demographics
NPI:1598999260
Name:RIDDER, KALINA MARIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KALINA
Middle Name:MARIE
Last Name:RIDDER
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 1:2013 STONELEIGH DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5633
Mailing Address - Country:US
Mailing Address - Phone:402-984-6234
Mailing Address - Fax:
Practice Address - Street 1:485 W 1400 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-7000
Practice Address - Country:US
Practice Address - Phone:801-426-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7221459-2401225100000X
CA34868225100000X
NE2593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist