Healthcare Provider Details

I. General information

NPI: 1801501226
Provider Name (Legal Business Name): RILEY IRWIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30940 STAGECOACH BLVD
EVERGREEN CO
80439-7984
US

IV. Provider business mailing address

4800 N 44TH ST
PHOENIX AZ
85018-3800
US

V. Phone/Fax

Practice location:
  • Phone: 303-674-1594
  • Fax:
Mailing address:
  • Phone: 602-808-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP055372T
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32805
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: