Provider Demographics
NPI:1710207220
Name:RIDDLE, DARLA (PTA)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 S 525 E
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-9602
Mailing Address - Country:US
Mailing Address - Phone:765-662-0937
Mailing Address - Fax:
Practice Address - Street 1:1302 S 525 E
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-9602
Practice Address - Country:US
Practice Address - Phone:765-662-0937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant