Provider Demographics
NPI:1760047385
Name:RIDDER, JENNA LEIGH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEIGH
Last Name:RIDDER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LEIGH
Other - Last Name:HUFFARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:7606 N UNION BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3873
Mailing Address - Country:US
Mailing Address - Phone:719-667-0666
Mailing Address - Fax:719-594-5658
Practice Address - Street 1:7606 N UNION BLVD STE F
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3873
Practice Address - Country:US
Practice Address - Phone:719-667-0666
Practice Address - Fax:719-594-5658
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist