Provider Demographics
NPI:1811798333
Name:GRIFFIN, RILEIGH M (DPT)
Entity type:Individual
Prefix:
First Name:RILEIGH
Middle Name:M
Last Name:GRIFFIN
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:RILEIGH
Other - Middle Name:M
Other - Last Name:BELLITTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28 DOGWOOD TER
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-1934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3417 ANDERSON HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-7784
Practice Address - Country:US
Practice Address - Phone:618-288-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070026482261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy