Provider Demographics
NPI:1669368742
Name:RILEY, WALKER J
Entity type:Individual
Prefix:
First Name:WALKER
Middle Name:J
Last Name:RILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4682
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84323-4682
Mailing Address - Country:US
Mailing Address - Phone:435-514-5646
Mailing Address - Fax:435-774-1919
Practice Address - Street 1:258 S MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5768
Practice Address - Country:US
Practice Address - Phone:435-383-6120
Practice Address - Fax:435-557-8003
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14223860-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist