Provider Demographics
NPI:1972768562
Name:RIFFLE, RICHARD A (CP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:RIFFLE
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 16TH AVE SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9213
Mailing Address - Country:US
Mailing Address - Phone:828-994-4808
Mailing Address - Fax:
Practice Address - Street 1:3305 16TH AVE SE
Practice Address - Street 2:SUITE 101
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9213
Practice Address - Country:US
Practice Address - Phone:828-994-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795419Medicaid