| NPI | 1114222593 |
|---|---|
| Former Name | ALICIA SHANNON RILEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2079810) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AL 5563) |
| Enumeration Date | 2011-01-17 |
| Last Update Date | 2011-01-17 |