Healthcare Provider Details

I. General information

NPI: 1821273863
Provider Name (Legal Business Name): KIMBERLY ANASTASIA RILEY MPT,CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 N SHERIDAN RD
PEORIA IL
61614-5927
US

IV. Provider business mailing address

414 BITTERSWEET AVE
GERMANTOWN HILLS IL
61548-8643
US

V. Phone/Fax

Practice location:
  • Phone: 309-431-1357
  • Fax: 309-410-3050
Mailing address:
  • Phone: 309-431-1357
  • Fax: 309-410-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.028846
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: