Provider Demographics
NPI:1295960862
Name:RILEY, CURT J (PT)
Entity type:Individual
Prefix:
First Name:CURT
Middle Name:J
Last Name:RILEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:
Practice Address - Street 1:1002 W CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6123
Practice Address - Country:US
Practice Address - Phone:715-858-4694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11277-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI861600019OtherMEDICARE PTAN
WI866520022OtherMEDICARE PTAN
WI171510006OtherMEDICARE PTAN
WI813790013OtherMEDICARE PTAN
WI860150020OtherMEDICARE PTAN
WI865190024OtherMEDICARE PTAN
WI860300024OtherMEDICARE PTAN
WI860350016OtherMEDICARE PTAN
WI1295960862Medicaid
WI860050011OtherMEDICARE PTAN