Provider Demographics
NPI:1306482963
Name:RIFFLE, KIMBERLY ANN-MARIE (MPT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN-MARIE
Last Name:RIFFLE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 PROSPECT BAY DR W
Mailing Address - Street 2:
Mailing Address - City:GRASONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21638-1186
Mailing Address - Country:US
Mailing Address - Phone:443-742-7441
Mailing Address - Fax:
Practice Address - Street 1:28438 MARLBORO AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2732
Practice Address - Country:US
Practice Address - Phone:410-822-2440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist