Provider Demographics
NPI:1538441019
Name:MARC T RILEY, PT, PC
Entity type:Organization
Organization Name:MARC T RILEY, PT, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:T
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS ATC CSCS
Authorized Official - Phone:607-346-7587
Mailing Address - Street 1:808 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-2324
Mailing Address - Country:US
Mailing Address - Phone:607-346-7587
Mailing Address - Fax:
Practice Address - Street 1:2667 OLD CORNING RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-4202
Practice Address - Country:US
Practice Address - Phone:607-346-7587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY620278612251X0800X
NY620297762251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty