Provider Demographics
NPI:1689561748
Name:RIDDLE, WALTER JAMES II (MA 61338028)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:JAMES
Last Name:RIDDLE
Suffix:II
Gender:M
Credentials:MA 61338028
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9511 NE HAZEL DELL AVE APT 84
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8058
Mailing Address - Country:US
Mailing Address - Phone:360-998-9033
Mailing Address - Fax:
Practice Address - Street 1:1417 NE 76TH ST STE B
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0485
Practice Address - Country:US
Practice Address - Phone:360-998-9033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-21
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61338028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist