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General NPI Number Information
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NPI Number | 1710308119
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Entity Type | Organization
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Legal Business Name | RIESTER PHYSICAL THERAPY SERVICES PC
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 12/13/2018
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Provider Practice Location Address
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Address Line | 6997 CAMPBELL BLVD
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-9605
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Country | US
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Telephone | 716-932-7525
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Fax | 716-630-9200
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Provider Business Mailing Address
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Address Line | RIESTER PHYSICAL THERAPY SERVICES 2801 WEHRLE DR. SUITE #7
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-7381
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Country | US
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Telephone | 716-932-7525
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Fax | 716-630-9200
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAWN PATRICK RIESTER
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Credential | DPT
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Telephone | 716-932-7525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 266639165
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License Number State | NY
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