Individual provider Active NPI

Adam Riddle, DPT

  • Physical Therapist
  • Lake Wylie, SC
National Provider Identifier
1114475696
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8610 Issued in SC
Practice address
439 Channel Rd Ste 102
Lake Wylie, SC 29710-6101
Phone
(803) 746-7800
Fax
(803) 746-7807
NPI assigned
Sep 14, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 8610 SC Primary

Addresses

Primary practice location

439 Channel Rd Ste 102
Lake Wylie, SC 29710-6101

Mailing address

1311 Mamaroneck Ave Ste 140
White Plains, NY 10605-5224
Phone (914) 294-4050

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171128001356 SC Practitioner - Physical Therapist in Private Practice 1658659792 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Focus, Inc.Group PAC ID 5890851406, 39 clinicians

Practice addresses (Care Compare)

439 Channel Rd
Suite 102
Lake Wylie, SC 29710-6101
Phone (803) 746-7800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8610SCMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Focus, Inc. Physical Therapist CurrentSince Apr 4, 2022 Accepting new patients
Palmetto Rehabilitation Specialists, LLC Physical Therapist CurrentSince Sep 12, 2017 Accepting new patients
Ivyrehab Focus, Inc. CurrentSince Apr 4, 2022 Accepting new patients
Agilitas USA Inc Physical Therapist Past Accepting new patients

Locations

1311 Mamaroneck Ave
Ste 140
White Plains, NY 10605
Phone (914) 265-4838

105 Ben Casey Dr
Ste 127
Fort Mill, SC 29708
Phone (803) 448-3200

439 Channel Rd
Ste 102
Lake Wylie, SC 29710
Phone (619) 977-0480

1738 Celanese Rd
#102
Rock Hill, SC 29732
Phone (803) 670-3067

1757 Ebenezer Rd
Rock Hill, SC 29732
Phone (803) 329-4685

1514 Alexander Love Hwy E
Ste 116
York, SC 29745
Phone (803) 628-2220

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745798400000",
    "number": "1114475696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "914-294-4050",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "439 CHANNEL RD STE 102",
            "city": "LAKE WYLIE",
            "state": "SC",
            "postal_code": "297106101",
            "telephone_number": "803-746-7800",
            "fax_number": "803-746-7807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDLE",
        "first_name": "ADAM",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-09-14",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "8610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Wylie, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.