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NPI Code Detail

MEDICARE: CHRISTI P RILEY DPT OCS ATC CSCS

MEDICARE: CHRISTI P RILEY DPT OCS ATC CSCS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT22704CA
22251X0800XOrthopedic Physical TherapistPT00010460WA
3225100000XPhysical TherapistPT-00010460WA

General Provider Information

NPI Number : 1144266230
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTI P RILEY DPT OCS ATC CSCS
Provider Business Mailing Address
First Line : 1940 S BONITO WAY STE 190
Second Line :
City : MERIDIAN
State : ID
Zip : 83642-5618
Country : US
Telephone Number : 208-287-9420
Fax Number :
Provider Business Practice Location Address
First Line : 17833 1ST AVE S
Second Line :
City : NORMANDY PARK
State : WA
Zip : 98148-1713
Country : US
Telephone Number : 253-330-8518
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2006
Last Update Date : 02/22/2023

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1598300824 — KINTSUGI PHYSICAL THERAPY
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Directions to “ CHRISTI P RILEY DPT OCS ATC CSCS” Practice Location

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