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General NPI Number Information
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NPI Number | 1265169890
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Entity Type | Individual
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Provider Name | JOSHUA RILEY PTA
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Gender | Male
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 3872 ATTUCKS DR
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City | POWELL
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State | OH
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Zip | 43065-6164
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Country | US
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Telephone | 614-588-0213
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Fax |
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Provider Business Mailing Address
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Address Line | 1430 DEER RUN RD
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City | NEWARK
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State | OH
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Zip | 43055-1771
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA.07294
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License Number State | OH
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