Provider Demographics
NPI:1255157293
Name:RIEDEL, ADAM HARRIS (PT, DPT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:HARRIS
Last Name:RIEDEL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 VIRGINIA AVE APT 6109
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-4424
Mailing Address - Country:US
Mailing Address - Phone:817-995-5278
Mailing Address - Fax:
Practice Address - Street 1:6001 HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4103
Practice Address - Country:US
Practice Address - Phone:817-370-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist