Provider Demographics
NPI:1740881820
Name:RIDDEL PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:RIDDEL PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDDEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CCI
Authorized Official - Phone:970-988-5529
Mailing Address - Street 1:132 SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:PALISADE
Mailing Address - State:CO
Mailing Address - Zip Code:81526-9709
Mailing Address - Country:US
Mailing Address - Phone:970-639-0248
Mailing Address - Fax:
Practice Address - Street 1:117 MAIN ST
Practice Address - Street 2:
Practice Address - City:PALISADE
Practice Address - State:CO
Practice Address - Zip Code:81526-5046
Practice Address - Country:US
Practice Address - Phone:970-639-0248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty