Individual
JONATHAN MICHAEL RIDDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3401 W GORE BLVD, LAWTON, OK 73505-6332
(580) 355-8620
Mailing address
4 W RAZORBACK RD, ROGERS, AR 72758-9570
(479) 899-4049
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA4317
AR
Other
Enumeration date
07/09/2018
Last updated
07/09/2018
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