Healthcare Provider Details

I. General information

NPI: 1073233656
Provider Name (Legal Business Name): RILEY BOLAND PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 VALLEY WEST DR STE 300
WEST DES MOINES IA
50266-1904
US

IV. Provider business mailing address

1200 VALLEY WEST DR STE 300
WEST DES MOINES IA
50266-1904
US

V. Phone/Fax

Practice location:
  • Phone: 515-440-3439
  • Fax: 515-440-3832
Mailing address:
  • Phone: 515-440-3439
  • Fax: 515-440-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number116050
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: