Healthcare Provider Details

I. General information

NPI: 1336553213
Provider Name (Legal Business Name): MALLORY RIGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MALLORY SIGLE

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 COURT ST
EVERGREEN AL
36401-2847
US

IV. Provider business mailing address

1908 FLINT RD SE
DECATUR AL
35601-6031
US

V. Phone/Fax

Practice location:
  • Phone: 251-578-6863
  • Fax: 251-578-6865
Mailing address:
  • Phone: 256-340-9708
  • Fax: 256-340-9624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPTH6914
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier529917620
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier1003819608
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerGROUP NPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: