Provider Demographics
NPI:1568452415
Name:RILEY, KATHY A (PT, CHT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:RILEY
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 RAY C HUNT DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2981
Practice Address - Country:US
Practice Address - Phone:434-244-2015
Practice Address - Fax:434-243-0320
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206192225100000X
IN05008629A225100000X
GA008234225100000X
KY004714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00777042OtherRAILROAD MEDICARE
VA192939OtherBCBS (PHYSICAL THERAPY)
VA7939472OtherAETNA
VA1568452415Medicaid
VAP00777042OtherRAILROAD MEDICARE
VAC05954Medicare PIN
KY0988906Medicare PIN
VA021967T54Medicare PIN