Healthcare Provider Details

I. General information

NPI: 1063780922
Provider Name (Legal Business Name): ASHLEY RIECK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-8501
US

IV. Provider business mailing address

2600 OLD CREEK CT
LEAVENWORTH KS
66048-4396
US

V. Phone/Fax

Practice location:
  • Phone: 913-683-8643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-06573
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: