MEDICARE: RILEY ALLEN TERRY PA-C

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	363A00000X	Physician Assistant	163831	MT

General Provider Information

NPI Number	:	1477416329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY ALLEN TERRY PA-C

Provider Business Mailing Address
First Line	:	250 GRANDVIEW WAY
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-3353
Country	:	US
Telephone Number	:	406-274-6107
Fax Number	:

Provider Business Practice Location Address
First Line	:	2360 MULLAN RD
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1811
Country	:	US
Telephone Number	:	406-721-4436
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ RILEY ALLEN TERRY PA-C” Practice Location

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