Provider Demographics
NPI:1376729806
Name:RILEY, SEAN (PT)
Entity Type:Individual
Prefix:
First Name:SEAN
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 1:210 COMMERCE WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8200
Mailing Address - Country:US
Mailing Address - Phone:603-427-8066
Mailing Address - Fax:603-501-0495
Practice Address - Street 1:3 FERRY ST
Practice Address - Street 2:SUITE F
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01835-7442
Practice Address - Country:US
Practice Address - Phone:978-469-9412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3296225100000X
MA16585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist