Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 9059291-2401 | UT |
NPI | 1285081356 |
---|---|
Provider Name | Andrew Scott Riddle |
First Address | Midvale, UT 84047-2615 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2016 |
Last Update Date | 01/12/2021 |