Provider Demographics
NPI:1629441258
Name:RYDER, JOSHUA (CO)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:RYDER
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 STANTON BOULAVARD
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:MI
Mailing Address - Zip Code:49437-9519
Mailing Address - Country:US
Mailing Address - Phone:239-894-0045
Mailing Address - Fax:
Practice Address - Street 1:4915 STANTON BLVD
Practice Address - Street 2:
Practice Address - City:MONTAGUE
Practice Address - State:MI
Practice Address - Zip Code:49437-1039
Practice Address - Country:US
Practice Address - Phone:239-894-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist