Provider Demographics
NPI:1356801559
Name:RIDGEWAY, JULIE CHRISTINE (PTA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:CHRISTINE
Last Name:RIDGEWAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BANBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2537
Mailing Address - Country:US
Mailing Address - Phone:916-605-6346
Mailing Address - Fax:
Practice Address - Street 1:4367 CONCORD BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-1145
Practice Address - Country:US
Practice Address - Phone:925-689-7457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA49245225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant