Provider Demographics
NPI:1649307141
Name:RIDDLE, JEAN (LPT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 BINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-1007
Mailing Address - Country:US
Mailing Address - Phone:412-995-5000
Mailing Address - Fax:412-995-5044
Practice Address - Street 1:711 BINGHAM ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1007
Practice Address - Country:US
Practice Address - Phone:412-995-5000
Practice Address - Fax:412-995-5044
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002484L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist