Doctor Name: | KEVIN RIDDLE |
NPI Number: | 1518297027 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CMT, LMT, LMTI |
License Number: | 5170 |
Business Practice Address: | 1240 Linden Ave Apt A Boulder, CO - 803041549 |
Business Phone Number: | 3032491054 |
Business Fax Number: | |
Mailing Address: | 1240 Linden Ave Apt A, BOULDER |
State: | CO |
Postal Code: | 803041549 |
Phone Number: | 3032491054 |
Fax Number: | |
NPI Enumeration Date: | 01/05/2010 |
NPI Last Update Date: | 05/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 5170 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NM |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |