1912276478 NPI number — MRS. CHRISTY SCOTT RIDER M.P.T.

Table of content: MRS. CHRISTY SCOTT RIDER M.P.T. (NPI 1912276478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912276478 NPI number — MRS. CHRISTY SCOTT RIDER M.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIDER
Provider First Name:
CHRISTY
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912276478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 392
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATSON
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-791-7770
Provider Business Mailing Address Fax Number:
225-791-7725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35055 LA HWY 16
Provider Second Line Business Practice Location Address:
SUITE 1-C
Provider Business Practice Location Address City Name:
DENHAM SPRINGS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-791-7770
Provider Business Practice Location Address Fax Number:
225-791-7725
Provider Enumeration Date:
12/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  06911 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com