Provider Demographics
NPI:1659929354
Name:MCCALISTER, RILEY
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:MCCALISTER
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 1:101 ISADORE ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5747
Mailing Address - Country:US
Mailing Address - Phone:318-663-8228
Mailing Address - Fax:318-214-9009
Practice Address - Street 1:120 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5026
Practice Address - Country:US
Practice Address - Phone:318-214-0088
Practice Address - Fax:318-214-9009
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10444R225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty