Provider Demographics
NPI:1437340841
Name:RIERSON, PAUL ANDREW (RPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:RIERSON
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 MASSACHUSETTS ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-3042
Mailing Address - Country:US
Mailing Address - Phone:785-832-1900
Mailing Address - Fax:785-832-1938
Practice Address - Street 1:2142 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-3042
Practice Address - Country:US
Practice Address - Phone:785-832-1900
Practice Address - Fax:785-832-1938
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist