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General NPI Number Information
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NPI Number | 1295051324
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Entity Type | Individual
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Provider Name | BEATRICE A RIDDELL P.T.
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Gender | Female
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 619 E SPRINGHILL DR
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City | TERRE HAUTE
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State | IN
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Zip | 47802-4448
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Country | US
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Telephone | 812-232-3504
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Fax |
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Provider Business Mailing Address
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Address Line | 6918 N PRIVATE ROAD 70 W
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City | BRAZIL
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State | IN
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Zip | 47834-8331
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Country | US
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Telephone | 309-912-4858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05009320A
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License Number State | IN
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