MEDICARE: RANDY RIEDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	30020	CA
2	225100000X	Physical Therapist	2704	HI

General Provider Information

NPI Number	:	1427378959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY RIEDER

Provider Business Mailing Address
First Line	:	5728 SUNSET FALLS DR
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-3113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5728 SUNSET FALLS DR
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-3113
Country	:	US
Telephone Number	:	805-455-7831
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	06/07/2010

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Directions to “ RANDY RIEDER ” Practice Location

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