Provider Demographics
NPI:1568675825
Name:RISCH, VIVIAN LOUESE (PHYSICIAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:LOUESE
Last Name:RISCH
Suffix:
Gender:F
Credentials:PHYSICIAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2609
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676
Mailing Address - Country:US
Mailing Address - Phone:512-847-2867
Mailing Address - Fax:
Practice Address - Street 1:555 FM 3237
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676
Practice Address - Country:US
Practice Address - Phone:512-847-5540
Practice Address - Fax:512-847-0419
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2032696225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant