Provider Demographics
NPI:1861909087
Name:RIDDLE, BENJAMIN SCOTT
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:RIDDLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:682 BREEDLOVE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE TOXAWAY
Mailing Address - State:NC
Mailing Address - Zip Code:28747-8687
Mailing Address - Country:US
Mailing Address - Phone:828-556-1521
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CULLOWHEE
Practice Address - State:NC
Practice Address - Zip Code:28723-9646
Practice Address - Country:US
Practice Address - Phone:828-556-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer