Provider Demographics
NPI:1891350062
Name:RIGGINS, ELIZABETH OSBURN (LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:OSBURN
Last Name:RIGGINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:OSBURN
Other - Last Name:THRIFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:4472 MOLLY BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-4134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:406 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-1904
Practice Address - Country:US
Practice Address - Phone:912-282-9060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000535225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty