Provider Demographics
NPI:1942746292
Name:RILEY, ALLISON (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 W CONESTOGA TRL
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-2081
Mailing Address - Country:US
Mailing Address - Phone:847-338-4463
Mailing Address - Fax:
Practice Address - Street 1:3720 W CONESTOGA TRL
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-2081
Practice Address - Country:US
Practice Address - Phone:847-338-4463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160007585225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant