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General NPI Number Information
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NPI Number | 1538441019
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Entity Type | Organization
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Legal Business Name | MARC T RILEY, PT, PC
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Dates
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Enumeration Date | 09/12/2011
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 2667 OLD CORNING RD
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City | HORSEHEADS
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State | NY
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Zip | 14845-4202
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Country | US
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Telephone | 607-346-7587
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Fax |
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Provider Business Mailing Address
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Address Line | 808 W CHURCH ST
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City | ELMIRA
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State | NY
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Zip | 14905-2324
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Country | US
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Telephone | 607-346-7587
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARC T RILEY
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Credential | PT OCS ATC CSCS
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Telephone | 607-346-7587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 62027861
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 62029776
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License Number State | NY
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