Provider Demographics
NPI:1093135857
Name:RILEY, ZACHARY (PT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:RILEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 HAMEL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-2701
Mailing Address - Country:US
Mailing Address - Phone:610-416-5919
Mailing Address - Fax:
Practice Address - Street 1:491 JOHN YOUNG WAY STE 210
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2567
Practice Address - Country:US
Practice Address - Phone:610-524-7251
Practice Address - Fax:610-280-1506
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01984100225100000X
PARTO0001842255A2300X
NJ25MT001927002255A2300X
PAPT028379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer