MEDICARE: RILEY WILSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	248400	AK

General Provider Information

NPI Number	:	1427903533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY WILSON

Provider Business Mailing Address
First Line	:	19839 TULWAR DR
Second Line	:
City	:	CHUGIAK
State	:	AK
Zip	:	99567-6353
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 N HEMMER RD APT 109
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-9673
Country	:	US
Telephone Number	:	907-795-8115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “ RILEY WILSON ” Practice Location

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