Provider Demographics
NPI:1730576836
Name:KORB, RIKKA CHIANG
Entity type:Individual
Prefix:
First Name:RIKKA
Middle Name:CHIANG
Last Name:KORB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ELM ST UNIT 702
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2517
Mailing Address - Country:US
Mailing Address - Phone:727-743-5130
Mailing Address - Fax:
Practice Address - Street 1:1200 ELM ST UNIT 702
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2517
Practice Address - Country:US
Practice Address - Phone:727-743-5130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1184225200000X
FL39606225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant