Provider Demographics
NPI:1457115412
Name:RIORDAN, CASEY JO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JO
Last Name:RIORDAN
Suffix:
Gender:F
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 1:1084 N EL CAMINO REAL # B351
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1334
Mailing Address - Country:US
Mailing Address - Phone:760-918-9200
Mailing Address - Fax:760-918-9203
Practice Address - Street 1:100 E SAN MARCOS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2989
Practice Address - Country:US
Practice Address - Phone:760-798-0150
Practice Address - Fax:760-798-0151
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist