Provider Demographics
NPI:1982991105
Name:RILEY, ASHLEY J (PT, DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:J
Last Name:RILEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ALYDAR DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4804
Mailing Address - Country:US
Mailing Address - Phone:319-200-6102
Mailing Address - Fax:
Practice Address - Street 1:101 3RD AVE SW STE 102
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5736
Practice Address - Country:US
Practice Address - Phone:319-200-6102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400050958Medicare PIN
IN000000731106OtherBLUE CROSS BLUE SHIELD
IN201029960Medicaid
INM400050964Medicare PIN
INM400050965Medicare PIN
IN000000731074OtherBLUE CROSS BLUE SHIELD