Provider Demographics
NPI:1679097117
Name:DOTY, RYDER (CPOA, CFO, CFTS)
Entity Type:Individual
Prefix:
First Name:RYDER
Middle Name:
Last Name:DOTY
Suffix:
Gender:M
Credentials:CPOA, CFO, CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 ALVARADO DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-2940
Mailing Address - Country:US
Mailing Address - Phone:818-521-6829
Mailing Address - Fax:
Practice Address - Street 1:124 ALVARADO DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-2940
Practice Address - Country:US
Practice Address - Phone:505-266-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter