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General NPI Number Information
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NPI Number | 1366106569
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Entity Type | Individual
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Provider Name | RILEY RECK
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Gender |
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 2235 MERCURY WAY STE 107
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City | SANTA ROSA
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State | CA
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Zip | 95407-5472
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Country | US
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Telephone | 707-571-5581
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Fax |
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Provider Business Mailing Address
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Address Line | 2235 MERCURY WAY STE 107
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City | SANTA ROSA
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State | CA
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Zip | 95407-5472
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Country | US
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Telephone | 707-981-2294
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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