Provider Demographics
NPI:1962591677
Name:RILEY, LYNN T (PT)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:T
Last Name:RILEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3517 GREENWAY DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4274
Mailing Address - Country:US
Mailing Address - Phone:706-833-5513
Mailing Address - Fax:706-855-1070
Practice Address - Street 1:4300 EVANS TO LOCKS RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-8028
Practice Address - Country:US
Practice Address - Phone:706-737-9250
Practice Address - Fax:706-733-0697
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0010602251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00552285CMedicaid