Provider Demographics
NPI:1487869848
Name:RILEY, ALESHA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALESHA
Middle Name:
Last Name:RILEY
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 1:2619 W AGATITE AVE APT 1H
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3089
Mailing Address - Country:US
Mailing Address - Phone:314-497-8912
Mailing Address - Fax:
Practice Address - Street 1:4721 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7553
Practice Address - Country:US
Practice Address - Phone:773-770-3682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70015665225100000X
IL070.015665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1487869848OtherNPI