Provider Demographics
NPI:1942604186
Name:RIDLEN, DANIELLE J (PTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:J
Last Name:RIDLEN
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 1:810 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:KS
Mailing Address - Zip Code:67749-2450
Mailing Address - Country:US
Mailing Address - Phone:785-475-2208
Mailing Address - Fax:
Practice Address - Street 1:810 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:KS
Practice Address - Zip Code:67749-2450
Practice Address - Country:US
Practice Address - Phone:785-475-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02409225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant