Individual
RANDY H. RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
404 N MAIN ST, ENTERPRISE, AL 36330-2563
(334) 308-9797
(334) 836-2247
Mailing address
PO BOX 729, DOTHAN, AL 36302-0729
(334) 793-2663
(334) 836-2247
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH3681
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121690
—
AL
01
—
511-09120
BCBS OF ALABAMA
AL
01
—
515-21795
BCBS - EPR REHAB
AL
05
—
890011740
—
AL
Enumeration date
09/29/2005
Last updated
11/20/2014
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