Provider Demographics
NPI:1558810952
Name:SOBOSKY, RILEY
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:SOBOSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 S REGAL ST
Mailing Address - Street 2:SUITE NUMBER 103
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7957
Mailing Address - Country:US
Mailing Address - Phone:509-724-4430
Mailing Address - Fax:
Practice Address - Street 1:5608 S REGAL ST
Practice Address - Street 2:SUITE NUMBER 103
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7957
Practice Address - Country:US
Practice Address - Phone:509-724-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60657410225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant