Provider Demographics
NPI:1780958082
Name:RILEI, NICHOLAS PETER (PTA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PETER
Last Name:RILEI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 POPLAR ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1121
Practice Address - Country:US
Practice Address - Phone:906-482-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-04
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2084337225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant