Basic Information
| Provider Information | |||||||||
| NPI: | 1710308119 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIESTER PHYSICAL THERAPY SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | RIESTER PHYSICAL THERAPY SERVICES | ||||||||
| Address2: | 2801 WEHRLE DR. SUITE #7 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142217381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169327525 | ||||||||
| FaxNumber: | 7166309200 | ||||||||
| Practice Location | |||||||||
| Address1: | 6997 CAMPBELL BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141209605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7169327525 | ||||||||
| FaxNumber: | 7166309200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2014 | ||||||||
| LastUpdateDate: | 12/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | RIESTER | ||||||||
| AuthorizedOfficialFirstName: | SHAWN | ||||||||
| AuthorizedOfficialMiddleName: | PATRICK | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7169327525 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 266639165 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.