Provider Demographics
NPI:1467840132
Name:RIGGENBACH, DAWNA G (PT)
Entity Type:Individual
Prefix:
First Name:DAWNA
Middle Name:G
Last Name:RIGGENBACH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DAWNA
Other - Middle Name:G
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:11706 S WILLOW PL
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4359
Mailing Address - Country:US
Mailing Address - Phone:918-629-9790
Mailing Address - Fax:
Practice Address - Street 1:11706 S WILLOW PL
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4359
Practice Address - Country:US
Practice Address - Phone:918-629-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20652251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology