Provider Demographics
NPI:1508906652
Name:RIESZ, JAMES KEITH (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEITH
Last Name:RIESZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 OLD KINGS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254
Mailing Address - Country:US
Mailing Address - Phone:904-651-8302
Mailing Address - Fax:
Practice Address - Street 1:800 LOMAX STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254
Practice Address - Country:US
Practice Address - Phone:904-356-3223
Practice Address - Fax:904-356-3225
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist