Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 42095 | CA |
Y | 2251P0200X | Physical Therapist - Pediatrics | 42095 | CA |
NPI | 1053703025 |
---|---|
Provider Name | Carlene Rieber |
First Address | Santa Rosa, CA 95401-4676 |
Second Address | Santa Rosa, CA 95401-4676 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2015 |
Last Update Date | 26/02/2015 |