Provider Demographics
NPI:1053988188
Name:RAMBO, RILEY J (PT)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:J
Last Name:RAMBO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:4601 HARTFORD ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4603
Mailing Address - Country:US
Mailing Address - Phone:325-793-3400
Mailing Address - Fax:325-793-3587
Practice Address - Street 1:3001 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5129
Practice Address - Country:US
Practice Address - Phone:325-223-6300
Practice Address - Fax:325-793-3587
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1346618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1346618Medicaid
TX1346618OtherALL COMMERCIAL INSURANCES