Provider Demographics
NPI:1285777524
Name:RIEGER, SHARON LELA (PT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LELA
Last Name:RIEGER
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 1:78 W CULVER ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1228
Mailing Address - Country:US
Mailing Address - Phone:602-307-9566
Mailing Address - Fax:602-795-1231
Practice Address - Street 1:78 W CULVER ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1228
Practice Address - Country:US
Practice Address - Phone:602-307-9566
Practice Address - Fax:602-795-1231
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist