Provider Demographics
NPI:1386180073
Name:UNGARETTI, RILEY ALYSE (ATC)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:ALYSE
Last Name:UNGARETTI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:RILEY
Other - Middle Name:ALYSE
Other - Last Name:KENNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1955 WALL ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-5523
Mailing Address - Country:US
Mailing Address - Phone:406-249-8714
Mailing Address - Fax:
Practice Address - Street 1:401 S WYOMING ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2655
Practice Address - Country:US
Practice Address - Phone:406-249-8714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT807652255A2300X, 390200000X
MTATR-LAT-LIC15742255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program