Individual
KELLY STEWART RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
2060 RHINO XING, MILAN, TN 38358-5201
(731) 613-2214
Mailing address
537 HIGHWAY 70 EAST, BROWNSVILLE, TN 38012
(731) 780-0778
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0446631
—
TN
Enumeration date
07/19/2023
Last updated
08/01/2024
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