Individual
MR. CHARLES GUY RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1626 S WELLS AVE STE 105, MERIDIAN, ID 83642-4528
(208) 789-0200
(208) 288-2784
Mailing address
3140 W MILANO DR, SUITE 100, MERIDIAN, ID 83646-7290
(208) 895-0022
(208) 898-9308
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
RPT-1978
ID
225100000X
Physical Therapist
Primary
PT-1978
ID
Other
Enumeration date
10/03/2006
Last updated
04/12/2018
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