Provider Demographics
NPI:1912276478
Name:RIDER, CHRISTY SCOTT (MPT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:SCOTT
Last Name:RIDER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 392
Mailing Address - Street 2:
Mailing Address - City:WATSON
Mailing Address - State:LA
Mailing Address - Zip Code:70786
Mailing Address - Country:US
Mailing Address - Phone:225-791-7770
Mailing Address - Fax:225-791-7725
Practice Address - Street 1:35055 LA HWY 16
Practice Address - Street 2:SUITE 1-C
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706
Practice Address - Country:US
Practice Address - Phone:225-791-7770
Practice Address - Fax:225-791-7725
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist