Provider Demographics
NPI:1780844316
Name:RIDER WELLNESS & REHAB
Entity Type:Organization
Organization Name:RIDER WELLNESS & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-383-2641
Mailing Address - Street 1:2338 CUESTA LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3810
Mailing Address - Country:US
Mailing Address - Phone:214-383-2641
Mailing Address - Fax:214-383-9534
Practice Address - Street 1:820 S ALMA DR
Practice Address - Street 2:100
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3808
Practice Address - Country:US
Practice Address - Phone:214-383-2641
Practice Address - Fax:214-383-9534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154464709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty