Provider Demographics
NPI:1881162782
Name:RISINGER, VANESSA K (PTA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:K
Last Name:RISINGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-5065
Mailing Address - Country:US
Mailing Address - Phone:501-374-7565
Mailing Address - Fax:501-374-8026
Practice Address - Street 1:1516 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5065
Practice Address - Country:US
Practice Address - Phone:501-374-7565
Practice Address - Fax:501-374-8026
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2147225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty