Provider Demographics
NPI:1801958723
Name:RIESENMAN, ANN (PT)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:RIESENMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-1357
Mailing Address - Country:US
Mailing Address - Phone:973-209-0030
Mailing Address - Fax:973-209-0095
Practice Address - Street 1:406 ROUTE 23
Practice Address - Street 2:SUITE 4
Practice Address - City:FRANKLIN
Practice Address - State:NJ
Practice Address - Zip Code:07416-2132
Practice Address - Country:US
Practice Address - Phone:973-209-0030
Practice Address - Fax:973-209-0095
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00365400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist