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General NPI Number Information
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NPI Number | 1568129401
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Entity Type | Individual
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Provider Name | NATHAN P RILEY PTA
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Gender | Male
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Dates
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Enumeration Date | 11/28/2021
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Last Update Date | 11/28/2021
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Provider Practice Location Address
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Address Line | 43900 KENAI SPUR HWY UNIT C
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City | KENAI
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State | AK
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Zip | 99611-9708
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Country | US
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Telephone | 907-283-3340
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Fax | 907-283-3349
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Provider Business Mailing Address
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Address Line | 43900 KENAI SPUR HWY UNIT C
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City | KENAI
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State | AK
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Zip | 99611-9708
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Country | US
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Telephone | 907-283-3340
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Fax | 907-283-3349
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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 | 186497
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License Number State | AK
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