Provider Demographics
NPI:1710201652
Name:RIDDLE, DAWN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8226 STONELICK DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6509
Mailing Address - Country:US
Mailing Address - Phone:317-430-1010
Mailing Address - Fax:
Practice Address - Street 1:8226 STONELICK DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6509
Practice Address - Country:US
Practice Address - Phone:317-430-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005642A2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics