Provider Demographics
NPI:1518631589
Name:GROENEWOUD, RILEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:GROENEWOUD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8403
Mailing Address - Country:US
Mailing Address - Phone:828-687-4545
Mailing Address - Fax:
Practice Address - Street 1:436 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8403
Practice Address - Country:US
Practice Address - Phone:828-687-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist