Provider Demographics
NPI:1134666167
Name:RILEY, ALANNA
Entity type:Individual
Prefix:
First Name:ALANNA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALANNA
Other - Middle Name:
Other - Last Name:ULRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:4493 W LONE SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-4831
Mailing Address - Country:US
Mailing Address - Phone:801-882-4745
Mailing Address - Fax:
Practice Address - Street 1:4493 W LONE SHADOW LN
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-4831
Practice Address - Country:US
Practice Address - Phone:801-882-4745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-29
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5659486-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist