Provider Demographics
NPI:1205122439
Name:RYDER, JESSICA D (DPT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:D
Last Name:RYDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:D
Other - Last Name:MARCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:680 W NYE LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-1575
Mailing Address - Country:US
Mailing Address - Phone:775-882-2211
Mailing Address - Fax:775-882-2212
Practice Address - Street 1:680 W NYE LN
Practice Address - Street 2:SUITE 205
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-1575
Practice Address - Country:US
Practice Address - Phone:775-882-2211
Practice Address - Fax:775-882-2212
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1205122439Medicaid
NVFH478ZOtherMEDICARE PTAN