Provider Demographics
NPI:1851528418
Name:RIFFLE, ADAM SHAWN (ATC, ASOP)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:SHAWN
Last Name:RIFFLE
Suffix:
Gender:M
Credentials:ATC, ASOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 FAIRFOREST WAY
Mailing Address - Street 2:APT. 21205
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607
Mailing Address - Country:US
Mailing Address - Phone:304-593-1773
Mailing Address - Fax:
Practice Address - Street 1:175 PATEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601
Practice Address - Country:US
Practice Address - Phone:864-454-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer