Provider Demographics
NPI:1710308119
Name:RIESTER PHYSICAL THERAPY SERVICES PC
Entity Type:Organization
Organization Name:RIESTER PHYSICAL THERAPY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RIESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:716-932-7525
Mailing Address - Street 1:RIESTER PHYSICAL THERAPY SERVICES
Mailing Address - Street 2:2801 WEHRLE DR. SUITE #7
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7381
Mailing Address - Country:US
Mailing Address - Phone:716-932-7525
Mailing Address - Fax:716-630-9200
Practice Address - Street 1:6997 CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-9605
Practice Address - Country:US
Practice Address - Phone:716-932-7525
Practice Address - Fax:716-630-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266639165261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy