Provider Demographics
NPI:1013082460
Name:RIDGEWAY, STEVE LEE (PT)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:LEE
Last Name:RIDGEWAY
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 1:2690 MAY ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-9786
Mailing Address - Country:US
Mailing Address - Phone:541-386-2441
Mailing Address - Fax:541-386-5869
Practice Address - Street 1:2690 MAY ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-9786
Practice Address - Country:US
Practice Address - Phone:541-386-2441
Practice Address - Fax:541-386-5869
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR131461Medicare ID - Type Unspecified