Basic Information
| Provider Information | |||||||||
| NPI: | 1306482963 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIFFLE | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN-MARIE | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 PROSPECT BAY DR W | ||||||||
| Address2: | |||||||||
| City: | GRASONVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216381186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437427441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 28438 MARLBORO AVE | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216012732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108222440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2019 | ||||||||
| LastUpdateDate: | 11/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 18191 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.