MEDICARE: CORINA DIAN RIGGINS ATC

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	225200000X	Physical Therapy Assistant	36000385A	IN
2	225200000X	Physical Therapy Assistant	06003779A	IN
3	2255A2300X	Athletic Trainer	36000385A	IN

General Provider Information

NPI Number	:	1427018654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINA DIAN RIGGINS ATC

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	909 SAGAMORE PKWY W STE 917
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1443
Country	:	US
Telephone Number	:	765-463-0710
Fax Number	:	765-463-0711

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/17/2023

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Directions to “ CORINA DIAN RIGGINS ATC” Practice Location

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