Provider Demographics
NPI:1093824641
Name:RIESBECK, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:RIESBECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7339 W CHOCTAW RD
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2001
Mailing Address - Country:US
Mailing Address - Phone:708-361-8353
Mailing Address - Fax:
Practice Address - Street 1:10341 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4603
Practice Address - Country:US
Practice Address - Phone:708-423-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist