| Doctor Name: | JEREMY RIDDLE |
| NPI Number: | 1740683044 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | PT2331 |
| Business Practice Address: | 4 Downwind Ave Greenbrier, AR - 720589815 |
| Business Phone Number: | 5017305445 |
| Business Fax Number: | |
| Mailing Address: | 4 Downwind Ave, GREENBRIER |
| State: | AR |
| Postal Code: | 72058 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/30/2014 |
| NPI Last Update Date: | 09/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | PT2331 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |