Provider Demographics
NPI:1679904684
Name:RIGGS, NICOLAS ALAN
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:ALAN
Last Name:RIGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2869 VIKING DR
Mailing Address - Street 2:#165
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5990
Mailing Address - Country:US
Mailing Address - Phone:414-615-0665
Mailing Address - Fax:414-615-0667
Practice Address - Street 1:2869 VIKING DR
Practice Address - Street 2:#165
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5990
Practice Address - Country:US
Practice Address - Phone:414-615-0665
Practice Address - Fax:414-615-0667
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2030-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant