Provider Demographics
NPI:1518758358
Name:RIDGWAY, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10085 RED RUN BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4832
Mailing Address - Country:US
Mailing Address - Phone:410-363-7123
Mailing Address - Fax:
Practice Address - Street 1:10085 RED RUN BLVD STE 307
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4832
Practice Address - Country:US
Practice Address - Phone:410-363-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5303225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant