Provider Demographics
NPI:1629068861
Name:RIFE, DIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIA
Middle Name:
Last Name:RIFE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-1078
Mailing Address - Country:US
Mailing Address - Phone:276-935-6496
Mailing Address - Fax:276-935-5852
Practice Address - Street 1:1060 ANCHORAGE CIRCLE
Practice Address - Street 2:
Practice Address - City:VANSANT
Practice Address - State:VA
Practice Address - Zip Code:24656
Practice Address - Country:US
Practice Address - Phone:276-935-6496
Practice Address - Fax:276-935-5852
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305-003200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA265995OtherANTHEM
VA0049-78471Medicaid
VA0049-78471Medicaid