Provider Demographics
NPI:1801030895
Name:RIBOTTO, NIJE J (MSPT)
Entity type:Individual
Prefix:MR
First Name:NIJE
Middle Name:J
Last Name:RIBOTTO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WEBSTER ST
Mailing Address - Street 2:#2
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2708
Mailing Address - Country:US
Mailing Address - Phone:617-319-2611
Mailing Address - Fax:
Practice Address - Street 1:75 WEBSTER ST
Practice Address - Street 2:#2
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2708
Practice Address - Country:US
Practice Address - Phone:617-319-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist