MEDICARE: RILEY IRWIN DPT

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	225100000X	Physical Therapist	CP055372T	CO
2	225100000X	Physical Therapist	32805	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D08732152	OTHER	AZ	DRIVERS LICENSE

General Provider Information

NPI Number	:	1801501226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY IRWIN DPT

Provider Business Mailing Address
First Line	:	4800 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3800
Country	:	US
Telephone Number	:	602-808-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	30940 STAGECOACH BLVD
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-7984
Country	:	US
Telephone Number	:	303-674-1594
Fax Number	:

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

Provider Enumeration Date	:	01/19/2023
Last Update Date	:	05/07/2026

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Directions to “ RILEY IRWIN DPT” Practice Location

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