Provider Demographics
NPI:1053151456
Name:CHARLES, RILEY (DPT)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:CHARLES
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:21015 PATHFINDER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4002
Mailing Address - Country:US
Mailing Address - Phone:909-861-3511
Mailing Address - Fax:909-860-7900
Practice Address - Street 1:21015 PATHFINDER RD STE 100
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4002
Practice Address - Country:US
Practice Address - Phone:909-861-3511
Practice Address - Fax:909-860-7900
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA305969208100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation