Provider Demographics
NPI:1548341795
Name:RIDER, JONATHAN RICHARD (RPT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:RICHARD
Last Name:RIDER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754
Mailing Address - Country:US
Mailing Address - Phone:808-826-7433
Mailing Address - Fax:808-826-7437
Practice Address - Street 1:5-5161 KUHIO HWY.
Practice Address - Street 2:SUITE E 202
Practice Address - City:HANALEI
Practice Address - State:HI
Practice Address - Zip Code:96714-0000
Practice Address - Country:US
Practice Address - Phone:808-826-7433
Practice Address - Fax:808-826-7437
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI24572251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic