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General NPI Number Information
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NPI Number | 1588444145
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Entity Type | Individual
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Provider Name | SCOTT RIDDELL
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Gender | Male
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 1903 ASHEVILLE HWY STE D
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City | HENDERSONVILLE
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State | NC
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Zip | 28791-2168
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Country | US
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Telephone | 828-697-2770
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Fax |
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Provider Business Mailing Address
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Address Line | 35 SIMPSON ST APT 301
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City | ASHEVILLE
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State | NC
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Zip | 28803-1480
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Country | US
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Telephone | 843-735-9702
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 21410
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License Number State | NC
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