Roberta L Riddel, PT, DPT, CCI

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTL.0014977 Issued in CO

Practice address

321 Rood Ave Unit 100
Grand Junction, CO 81501-2420

Phone

(970) 325-6026

Fax

(970) 325-6169

NPI assigned

Jun 21, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Miss Roberta L Prins Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645401600000",
    "number": "1407376437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 SUNSET CIR",
            "city": "PALISADE",
            "state": "CO",
            "postal_code": "815269709",
            "telephone_number": "970-639-0248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 ROOD AVE UNIT 100",
            "city": "GRAND JUNCTION",
            "state": "CO",
            "postal_code": "815012420",
            "telephone_number": "970-325-6026",
            "fax_number": "970-325-6169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDEL",
        "first_name": "ROBERTA",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "PT, DPT, CCI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-21",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0014977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CO DORA",
            "identifier": "PTL.0014977",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CO DORA",
            "identifier": "PTL0014977",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROBERTA",
            "last_name": "PRINS",
            "middle_name": "L",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Robert Sean Richardson, PT
• Kathleen A Richmond, ORT-CERTIFIED
• Lisa Rickerd-Mills, MSW
• Robert Ricketts, MD
• Bruce Marc Ricks, D.D.S.
• Amanda Leann Riddle, PHARM. D
• Judy Ridenour
• Ronald Dean Ridgley, D.O.
• Ona Lucia Ridgway, NP
• Jennifer Ries, MSW, LSW

• Physical Therapist in Grand Junction, CO
• Providers in Grand Junction, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.