Healthcare Provider Details

I. General information

NPI: 1134161086
Provider Name (Legal Business Name): KELLY MAUREEN RILEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/26/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 VILLAGE PROFESSIONAL DR N
OPELIKA AL
36801-4734
US

IV. Provider business mailing address

1030 GREGORY GLEN RD
OPELIKA AL
36801-9417
US

V. Phone/Fax

Practice location:
  • Phone: 334-528-1964
  • Fax: 334-528-4610
Mailing address:
  • Phone: 334-826-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTH1172
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: