Provider Demographics
NPI:1356814826
Name:RILEY PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:RILEY PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, ATC, LAT, CKTP
Authorized Official - Phone:318-537-4376
Mailing Address - Street 1:214 WINKLER WAY
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-6527
Mailing Address - Country:US
Mailing Address - Phone:318-537-4376
Mailing Address - Fax:
Practice Address - Street 1:650 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2210
Practice Address - Country:US
Practice Address - Phone:318-537-4376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty