Provider Demographics
NPI:1427094671
Name:RILEY, PATRICIA L (PT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:L
Last Name:RILEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2163 BUFFALO DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-2544
Mailing Address - Country:US
Mailing Address - Phone:970-314-7345
Mailing Address - Fax:
Practice Address - Street 1:2163 BUFFALO DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507
Practice Address - Country:US
Practice Address - Phone:970-314-7345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO840999425004OtherHMO
CO840999425OtherTAX ID
CO86980220Medicaid
CO650010143OtherMEDICARE, RAILROAD
CO840999425004OtherHMO