Provider Demographics
NPI:1336128156
Name:RIDDLE, OPAL JEAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:OPAL
Middle Name:JEAN
Last Name:RIDDLE
Suffix:
Gender:F
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 1:441 IVY TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-2129
Mailing Address - Country:US
Mailing Address - Phone:513-528-0757
Mailing Address - Fax:
Practice Address - Street 1:2727 MADISON RD
Practice Address - Street 2:SUITE 301
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-2276
Practice Address - Country:US
Practice Address - Phone:513-871-5571
Practice Address - Fax:513-871-6761
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-03537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist