Provider Demographics
NPI:1417786104
Name:RILEY, TRICIA (PTA)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-2003
Mailing Address - Country:US
Mailing Address - Phone:862-684-5870
Mailing Address - Fax:
Practice Address - Street 1:487 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2003
Practice Address - Country:US
Practice Address - Phone:862-684-5870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPTA40QB00250100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant