Provider Demographics
NPI:1841074739
Name:WHITCOMB, RILEY (DPT)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RILEY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2824 SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-4020
Mailing Address - Country:US
Mailing Address - Phone:319-850-6639
Mailing Address - Fax:
Practice Address - Street 1:2800 PIERCE ST STE 110
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3707
Practice Address - Country:US
Practice Address - Phone:712-279-3754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA119938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist