Provider Demographics
NPI:1306834056
Name:RIEBE, ROBERT A (ATC, CPT, PES)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:RIEBE
Suffix:
Gender:M
Credentials:ATC, CPT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 POST RD
Mailing Address - Street 2:APT. 28301
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7078
Mailing Address - Country:US
Mailing Address - Phone:401-459-4001
Mailing Address - Fax:
Practice Address - Street 1:285 PROMENADE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-5719
Practice Address - Country:US
Practice Address - Phone:401-459-4001
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAT002142255A2300X, 2255R0406X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind