Provider Demographics
NPI:1821363359
Name:RIDINGER, SARAH THERESA (PTA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:THERESA
Last Name:RIDINGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W AGENCY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1704
Mailing Address - Country:US
Mailing Address - Phone:319-752-7899
Mailing Address - Fax:319-752-7774
Practice Address - Street 1:411 W AGENCY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1704
Practice Address - Country:US
Practice Address - Phone:319-752-7899
Practice Address - Fax:319-752-7774
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00966225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant