Provider Demographics
NPI:1528442191
Name:RIFFLE, MIKELL (MT)
Entity type:Individual
Prefix:
First Name:MIKELL
Middle Name:
Last Name:RIFFLE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:MIKELL
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:483 JAQUETTE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-5834
Mailing Address - Country:US
Mailing Address - Phone:970-260-9064
Mailing Address - Fax:
Practice Address - Street 1:483 JAQUETTE LN
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-5834
Practice Address - Country:US
Practice Address - Phone:970-260-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0008579225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist