Healthcare Provider Details

I. General information

NPI: 1972241263
Provider Name (Legal Business Name): COURTNEY NICOLE RIDENOUR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 04/22/2023
Certification Date: 04/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 WHIPPLE AVE NW
NORTH CANTON OH
44720-7618
US

IV. Provider business mailing address

6100 WHIPPLE AVE NW
NORTH CANTON OH
44720-7618
US

V. Phone/Fax

Practice location:
  • Phone: 330-305-6999
  • Fax:
Mailing address:
  • Phone: 330-305-6999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019914
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: