Provider Demographics
NPI:1689620510
Name:RIDDLE, GORDON C (PT)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:C
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 E ELFINWILD RD
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-3915
Mailing Address - Country:US
Mailing Address - Phone:412-213-0881
Mailing Address - Fax:412-231-0881
Practice Address - Street 1:4543 MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3108
Practice Address - Country:US
Practice Address - Phone:412-748-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist