Healthcare Provider Details

I. General information

NPI: 1164344719
Provider Name (Legal Business Name): RILEY DEAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24077 COUNTRY LIVING RD STE 8
MILLSBORO DE
19966-3188
US

IV. Provider business mailing address

212 NE 4TH ST
MILFORD DE
19963-1475
US

V. Phone/Fax

Practice location:
  • Phone: 302-648-5060
  • Fax:
Mailing address:
  • Phone: 302-757-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0011650
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: