MEDICARE: MRS. CAROLINE LOUISE RIBLETT PT, LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	7355	OR
2	225100000X	Physical Therapist	1170	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	007394000	OTHER	OR	BCBS ID NUMBER

General Provider Information

NPI Number	:	1992863179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLINE LOUISE RIBLETT PT, LMT

Provider Business Mailing Address
First Line	:	4036 S 6TH ST STE 4
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4750
Country	:	US
Telephone Number	:	541-883-3841
Fax Number	:	541-851-9365

Provider Business Practice Location Address
First Line	:	4036 S 6TH ST STE 4
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97603-4750
Country	:	US
Telephone Number	:	541-883-3841
Fax Number	:	541-851-9365

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	08/26/2019

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