Provider Demographics
NPI:1184847154
Name:RIESER, RENEE MICHELLE (PT, MS, PCS)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MICHELLE
Last Name:RIESER
Suffix:
Gender:F
Credentials:PT, MS, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8506 PRESERVATION WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-9598
Mailing Address - Country:US
Mailing Address - Phone:317-847-8217
Mailing Address - Fax:317-328-1257
Practice Address - Street 1:8506 PRESERVATION WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-9598
Practice Address - Country:US
Practice Address - Phone:317-847-8217
Practice Address - Fax:317-328-1257
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006221A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist