Provider Demographics
NPI:1487126652
Name:RIBA, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:RIBA
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 1:6625 FOXRUN EAST END DR
Mailing Address - Street 2:
Mailing Address - City:MABELVALE
Mailing Address - State:AR
Mailing Address - Zip Code:72103-9456
Mailing Address - Country:US
Mailing Address - Phone:501-529-4951
Mailing Address - Fax:
Practice Address - Street 1:201 DONAGHEY AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72035-5001
Practice Address - Country:US
Practice Address - Phone:501-450-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer