Provider Demographics
NPI:1841850070
Name:RIDDLE, ANA JEAN (DPT)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:JEAN
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:JEAN
Other - Last Name:HYDEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8538 METTEE ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-2075
Mailing Address - Country:US
Mailing Address - Phone:913-832-2226
Mailing Address - Fax:
Practice Address - Street 1:6911 TOMAHAWK RD
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-2618
Practice Address - Country:US
Practice Address - Phone:913-871-6291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019021507225100000X
KS11-06247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist