Basic Information
| Provider Information | |||||||||
| NPI: | 1780845487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RISENMAY | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1911 | ||||||||
| Address2: | |||||||||
| City: | SISTERS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977591911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5415493534 | ||||||||
| FaxNumber: | 5415491272 | ||||||||
| Practice Location | |||||||||
| Address1: | 4677 COMMERCIAL ST SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973021901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035855131 | ||||||||
| FaxNumber: | 5035854065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2008 | ||||||||
| LastUpdateDate: | 05/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5652 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.