Provider Demographics
NPI:1790230126
Name:RIGGS, BRYAN AUSTIN (DPT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:AUSTIN
Last Name:RIGGS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:BRYAN
Other - Middle Name:AUSTIN
Other - Last Name:RIGGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:165 STEVE BARRY BLVD
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-6841
Mailing Address - Country:US
Mailing Address - Phone:918-824-4500
Mailing Address - Fax:918-824-1977
Practice Address - Street 1:165 STEVE BARRY BLVD
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-6841
Practice Address - Country:US
Practice Address - Phone:918-824-4500
Practice Address - Fax:918-824-1977
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist