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NPI Code Detail

MEDICARE: DEAN RIGGLEMAN PT

MEDICARE: DEAN RIGGLEMAN PT
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
1225100000XPhysical TherapistPT7155GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT7155OTHERGASTATE LISC NUMBER

General Provider Information

NPI Number : 1710056973
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEAN RIGGLEMAN PT
Provider Business Mailing Address
First Line : PO BOX 518
Second Line :
City : JONESBORO
State : GA
Zip : 30237-0518
Country : US
Telephone Number : 770-631-8277
Fax Number : 770-631-9403
Provider Business Practice Location Address
First Line : 100 MOUNTAIN VIEW DR
Second Line : SUITE 100
City : CUMMING
State : GA
Zip : 30040-2434
Country : US
Telephone Number : 770-889-2163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 07/08/2007

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