=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053521534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TOM RIGGS MPT, CSCS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9120 W 75TH ST
-----------------------------------------------------
City | SHAWNEE MISSION
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66204-2210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-676-7778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16114 W 79TH TER
-----------------------------------------------------
City | LENEXA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66219-1674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-888-5572
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 11-02707
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------