Provider Demographics
NPI:1033412150
Name:RILEY, ELIZABETH ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:RILEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2479 ROSEWOOD N
Mailing Address - Street 2:STE. A
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-5004
Mailing Address - Country:US
Mailing Address - Phone:989-289-3755
Mailing Address - Fax:989-779-9419
Practice Address - Street 1:2479 ROSEWOOD N
Practice Address - Street 2:STE. A
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-5004
Practice Address - Country:US
Practice Address - Phone:989-289-3755
Practice Address - Fax:989-779-9419
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1810442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist