Provider Demographics
NPI:1558104513
Name:ALCORN, RILEY
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:ALCORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 E COUNTY ROAD 650 N
Mailing Address - Street 2:
Mailing Address - City:BUTLERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47223-9234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6900 E COUNTY ROAD 650 N
Practice Address - Street 2:
Practice Address - City:BUTLERVILLE
Practice Address - State:IN
Practice Address - Zip Code:47223-9234
Practice Address - Country:US
Practice Address - Phone:740-375-5759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer