Provider Demographics
NPI:1073946133
Name:RIEBL, BENJAMIN R (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:R
Last Name:RIEBL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N TRAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4012
Mailing Address - Country:US
Mailing Address - Phone:281-592-2884
Mailing Address - Fax:281-592-3269
Practice Address - Street 1:102 N TRAVIS AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4012
Practice Address - Country:US
Practice Address - Phone:281-592-2884
Practice Address - Fax:281-592-3269
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1232756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist