Healthcare Provider Details

I. General information

NPI: 1033760749
Provider Name (Legal Business Name): RACHEL R RIESTERER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL FISCHER

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 CUSTER ST STE D
MANITOWOC WI
54220-4328
US

IV. Provider business mailing address

744 S WEBSTER AVE
GREEN BAY WI
54301-3505
US

V. Phone/Fax

Practice location:
  • Phone: 920-652-9310
  • Fax: 920-652-9316
Mailing address:
  • Phone: 920-445-7210
  • Fax: 920-445-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14653
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: