# RILEY PHYSICAL THERAPY, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356814826
- **Authorized official:** MR. JASON C RILEY MPT, ATC, LAT, CKTP (PHYSICAL THERAPIST/PRESIDENT)
- **Authorized official phone:** (318) 537-4376

## Contact information

- **Practice address:** 650 OLIVE ST, SHREVEPORT, LA 71104-2210
- **Practice address phone:** (318) 537-4376
- **Mailing address:** 214 WINKLER WAY, MONROE, LA 71203-6527
- **Mailing address phone:** (318) 537-4376

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |

## Other

- **Enumeration date:** 01/08/2019
- **Last updated:** 01/08/2019