Provider Demographics
NPI:1154803260
Name:RILEY, DANIELLE MICHEA (PTA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MICHEA
Last Name:RILEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2415
Mailing Address - Country:US
Mailing Address - Phone:325-514-4968
Mailing Address - Fax:
Practice Address - Street 1:1951 HOWARD DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2415
Practice Address - Country:US
Practice Address - Phone:325-514-4968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2104001225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant