Provider Demographics
NPI:1811224447
Name:RIESDORPH, CARA (PT)
Entity Type:Individual
Prefix:MS
First Name:CARA
Middle Name:
Last Name:RIESDORPH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:GALLETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 CANISTEO ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-2104
Practice Address - Country:US
Practice Address - Phone:607-324-8280
Practice Address - Fax:607-324-8283
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist