1710308119 NPI number — RIESTER PHYSICAL THERAPY SERVICES PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710308119 NPI number — RIESTER PHYSICAL THERAPY SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIESTER PHYSICAL THERAPY SERVICES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710308119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RIESTER PHYSICAL THERAPY SERVICES
Provider Second Line Business Mailing Address:
2801 WEHRLE DR. SUITE #7
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-7381
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-932-7525
Provider Business Mailing Address Fax Number:
716-630-9200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6997 CAMPBELL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH TONAWANDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14120-9605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-932-7525
Provider Business Practice Location Address Fax Number:
716-630-9200
Provider Enumeration Date:
01/02/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RIESTER
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
716-932-7525

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  266639165 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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