Active NPI
Heather Ridenoure, PT, ATC
- Physical Therapist
- Rogers, AR
National Provider Identifier
1811526940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2068
- Practice address
- 5103 S Grove Dr
Rogers, AR 72758-8817 - Phone
- (479) 530-8699
- NPI assigned
- Apr 1, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2068 | AR | Primary |
Addresses
Primary practice location
5103 S Grove Dr
Rogers, AR 72758-8817
Mailing address
5103 S Grove Dr
Rogers, AR 72758-8817
Phone (479) 530-8699
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | heather@pretiumhealthcare.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2068 | AR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585699200000",
"number": "1811526940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5103 S GROVE DR",
"city": "ROGERS",
"state": "AR",
"postal_code": "727588817",
"telephone_number": "479-530-8699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5103 S GROVE DR",
"city": "ROGERS",
"state": "AR",
"postal_code": "727588817",
"telephone_number": "479-530-8699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDENOURE",
"first_name": "HEATHER",
"credential": "PT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-04-01",
"last_updated": "2020-04-01",
"certification_date": "2020-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "2068",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "heather@pretiumhealthcare.com",
"affiliation": "N",
"address_1": "5103 S Grove Dr",
"city": "Rogers",
"state": "AR",
"country_code": "US",
"postal_code": "727588817",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Rogers, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.