Provider Demographics
NPI:1609531698
Name:RIDEOUT, RENEE BETH (PTA)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:BETH
Last Name:RIDEOUT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CARTWRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1206
Mailing Address - Country:US
Mailing Address - Phone:607-563-2929
Mailing Address - Fax:
Practice Address - Street 1:4 CARTWRIGHT AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1206
Practice Address - Country:US
Practice Address - Phone:607-563-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004459-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation