Provider Demographics
NPI:1609624634
Name:WOOD, RILEY NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:NICOLE
Last Name:WOOD
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 1:11193 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8401
Mailing Address - Country:US
Mailing Address - Phone:801-415-9343
Mailing Address - Fax:801-415-9973
Practice Address - Street 1:11193 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8401
Practice Address - Country:US
Practice Address - Phone:801-415-9343
Practice Address - Fax:801-415-9973
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139641512401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist