Provider Demographics
NPI:1255373544
Name:RIDENOURE, ALAN SHAWN (MED, ATC/L, CSCS)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:SHAWN
Last Name:RIDENOURE
Suffix:
Gender:M
Credentials:MED, ATC/L, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 CHAMBERLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-2248
Mailing Address - Country:US
Mailing Address - Phone:251-625-3178
Mailing Address - Fax:
Practice Address - Street 1:1505 DAPHNE AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4298
Practice Address - Country:US
Practice Address - Phone:251-625-3176
Practice Address - Fax:251-625-3198
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer