Provider Demographics
NPI:1962455956
Name:RIDLEY, ASTLEY MARTIN (PT)
Entity Type:Individual
Prefix:
First Name:ASTLEY
Middle Name:MARTIN
Last Name:RIDLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 EAST 56TH STREET
Mailing Address - Street 2:DR'S OFFICE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-688-2016
Mailing Address - Fax:212-753-9856
Practice Address - Street 1:300 EAST 56TH STREET
Practice Address - Street 2:DR'S OFFICE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-688-2016
Practice Address - Fax:212-753-9856
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist