Active NPI
Corey M Ridley, ATC
- Athletic Trainer
- Lewiston, ME
National Provider Identifier
1922410786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT203
- Practice address
- 77 Bates St
Suite 201
Lewiston, ME 04240-7637 - Phone
- (207) 795-8465
- NPI assigned
- May 28, 2014
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT203 | ME | Primary |
Addresses
Primary practice location
77 Bates St
Suite 201
Lewiston, ME 04240-7637
Mailing address
266 Paris Rd
Hebron, ME 04238-3414
Phone (207) 212-2185
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 |
|---|---|---|---|
| AT203 | ME | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458864000000",
"number": "1922410786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "266 PARIS RD",
"city": "HEBRON",
"state": "ME",
"postal_code": "042383414",
"telephone_number": "207-212-2185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 BATES ST",
"address_2": "SUITE 201",
"city": "LEWISTON",
"state": "ME",
"postal_code": "042407637",
"telephone_number": "207-795-8465"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDLEY",
"first_name": "COREY",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-05-28",
"last_updated": "2016-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ME",
"license": "AT203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lewiston, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.