Provider Demographics
NPI:1265956411
Name:RIDGWAY, CAROLINA MARIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:MARIA
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9350 BRITTON ST APT 10204
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-2554
Mailing Address - Country:US
Mailing Address - Phone:314-791-7077
Mailing Address - Fax:
Practice Address - Street 1:100 NE TUDOR RD STE 110
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5601
Practice Address - Country:US
Practice Address - Phone:816-554-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017026655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist