Provider Demographics
NPI:1336420017
Name:RIESING, ROBERT (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:RIESING
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 EAGLE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8272
Mailing Address - Country:US
Mailing Address - Phone:847-421-9421
Mailing Address - Fax:
Practice Address - Street 1:1816 EAGLE DR
Practice Address - Street 2:SUITE C
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8272
Practice Address - Country:US
Practice Address - Phone:847-421-9421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist