Provider Demographics
NPI:1538466131
Name:RIGDON, ALTAIR (LMT, CMLDT, CPCP)
Entity Type:Individual
Prefix:
First Name:ALTAIR
Middle Name:
Last Name:RIGDON
Suffix:
Gender:F
Credentials:LMT, CMLDT, CPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1082 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2820
Mailing Address - Country:US
Mailing Address - Phone:632-682-1378
Mailing Address - Fax:631-803-0557
Practice Address - Street 1:1082 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2820
Practice Address - Country:US
Practice Address - Phone:632-682-1378
Practice Address - Fax:631-803-0557
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010260225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist