Provider Demographics
NPI:1609329259
Name:RILEY, RICHELLA (DPT)
Entity Type:Individual
Prefix:
First Name:RICHELLA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 S LAKE STEVENS RD UNIT E
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-2060
Mailing Address - Country:US
Mailing Address - Phone:425-334-1122
Mailing Address - Fax:425-334-1188
Practice Address - Street 1:1819 S LAKE STEVENS RD UNIT E
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2060
Practice Address - Country:US
Practice Address - Phone:425-334-1122
Practice Address - Fax:425-334-1188
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60657609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist