Healthcare Provider Details

I. General information

NPI: 1235063280
Provider Name (Legal Business Name): RILEY ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15410 S MOUNTAIN PKWY STE 112
PHOENIX AZ
85044-6691
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 480-940-8299
  • Fax: 480-704-0888
Mailing address:
  • Phone: 726-202-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034809
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: