Provider Demographics
NPI:1063651354
Name:RILEY-GOOD, LORI KAY (MPT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KAY
Last Name:RILEY-GOOD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9112
Mailing Address - Country:US
Mailing Address - Phone:937-653-7333
Mailing Address - Fax:937-652-4574
Practice Address - Street 1:1450 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9112
Practice Address - Country:US
Practice Address - Phone:937-653-7333
Practice Address - Fax:937-652-4574
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT012342225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist