Provider Demographics
NPI:1750131876
Name:RIGG, ANDREA KELLY (MPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KELLY
Last Name:RIGG
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:KELLY
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1118 VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-1870
Mailing Address - Country:US
Mailing Address - Phone:360-736-5273
Mailing Address - Fax:360-736-5053
Practice Address - Street 1:1118 VIEW AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1870
Practice Address - Country:US
Practice Address - Phone:360-736-5273
Practice Address - Fax:360-736-5053
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT61528298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist