Provider Demographics
NPI:1639306038
Name:RIDER, KATIE NOELLE (DPT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:NOELLE
Last Name:RIDER
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 1:751 RUNYAN DR
Mailing Address - Street 2:APT 810
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-1224
Mailing Address - Country:US
Mailing Address - Phone:423-779-8200
Mailing Address - Fax:
Practice Address - Street 1:2415 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3322
Practice Address - Country:US
Practice Address - Phone:423-624-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist