Provider Demographics
NPI:1558802066
Name:RILEY, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 ROBB DR
Mailing Address - Street 2:STE 103
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-3733
Mailing Address - Country:US
Mailing Address - Phone:775-787-3733
Mailing Address - Fax:
Practice Address - Street 1:3000 GOFFS FALLS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03111-1000
Practice Address - Country:US
Practice Address - Phone:800-995-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22066225100000X
CA291472225100000X
NV3253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist