Healthcare Provider Details

I. General information

NPI: 1881523249
Provider Name (Legal Business Name): CHARLES RYAN BIDDLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 CROSSINGS MALL RD
ELKVIEW WV
25071-9230
US

IV. Provider business mailing address

1500 BRIDGE RD APT 407
CHARLESTON WV
25314-3903
US

V. Phone/Fax

Practice location:
  • Phone: 305-965-7979
  • Fax:
Mailing address:
  • Phone: 304-360-0331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001902
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: