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General NPI Number Information
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NPI Number | 1669004172
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Entity Type | Individual
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Provider Name | SPIRIDOULA J. RILEY PT, DPT, ATC, MSAT
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Gender | Female
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 78 BAYBERRY DR
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City | SOMERSET
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State | NJ
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Zip | 08873-4208
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Country | US
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Telephone | 845-863-5310
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Fax |
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Provider Business Mailing Address
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Address Line | 78 BAYBERRY DR
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City | SOMERSET
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State | NJ
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Zip | 08873-4208
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Country | US
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Telephone | 845-863-5310
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00128300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01171600
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License Number State | NJ
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