Provider Demographics
NPI:1790230597
Name:RILEY, DANIEL (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:RILEY
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 1:4530 E SHEA BLVD
Mailing Address - Street 2:105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6065
Mailing Address - Country:US
Mailing Address - Phone:480-494-2050
Mailing Address - Fax:480-398-7318
Practice Address - Street 1:4530 E SHEA BLVD
Practice Address - Street 2:105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6065
Practice Address - Country:US
Practice Address - Phone:480-494-2050
Practice Address - Fax:480-398-7318
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12487PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist