Provider Demographics
NPI:1962009795
Name:RIGGIO, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:RIGGIO
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 1:25 NASSON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2426
Mailing Address - Country:US
Mailing Address - Phone:207-854-1124
Mailing Address - Fax:
Practice Address - Street 1:100 MERRIMACK ST STE 305
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1706
Practice Address - Country:US
Practice Address - Phone:277-413-3115
Practice Address - Fax:508-861-0190
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16703225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist