Provider Demographics
NPI:1922726645
Name:SHEA, RILEY OSTEN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:RILEY
Middle Name:OSTEN
Last Name:SHEA
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 1:101 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3811
Mailing Address - Country:US
Mailing Address - Phone:207-232-5062
Mailing Address - Fax:
Practice Address - Street 1:1023 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2793
Practice Address - Country:US
Practice Address - Phone:207-773-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT6332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist