Provider Demographics
NPI:1821401530
Name:ATWELL, RILEY TEGAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:TEGAN
Last Name:ATWELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:RILEY
Other - Middle Name:TEGAN
Other - Last Name:MAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:220 NW PLATTE VALLEY DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:MO
Practice Address - Zip Code:64150-9793
Practice Address - Country:US
Practice Address - Phone:816-505-3422
Practice Address - Fax:816-505-3312
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014024221225100000X
AR3827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA4370085OtherMEDICARE PTAN
50787013OtherBCBS-KC