Provider Demographics
NPI:1174103923
Name:FITZSIMONS, RILEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:FITZSIMONS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 N TRIPHAMMER RD APT M3E
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1512
Mailing Address - Country:US
Mailing Address - Phone:973-534-5657
Mailing Address - Fax:
Practice Address - Street 1:4600 SOUTHWOOD HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NY
Practice Address - Zip Code:13078-9595
Practice Address - Country:US
Practice Address - Phone:315-469-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist