Provider Demographics
NPI:1366004525
Name:CRIDDLE, CATHERINE ANNE
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNE
Last Name:CRIDDLE
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 1:969 ALLEN FARM RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-4955
Mailing Address - Country:US
Mailing Address - Phone:601-750-4151
Mailing Address - Fax:
Practice Address - Street 1:142 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8597
Practice Address - Country:US
Practice Address - Phone:601-750-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1366004525Medicaid