Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | P20833 | NC |
Y | 2251X0800X | Physical Therapist - Orthopedic | P20833 | NC |
NPI | 1457019838 |
---|---|
Provider Name | Dr. Creedence Christopher Riblett |
First Address | Cary, NC 27513-8431 |
Second Address | Cary, NC 27513-8431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2021 |
Last Update Date | 02/12/2021 |