Provider Demographics
NPI:1053571042
Name:RISDALL, CAROL MARIE (DPT)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:MARIE
Last Name:RISDALL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 FOREST HILLS DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4449
Mailing Address - Country:US
Mailing Address - Phone:605-388-9335
Mailing Address - Fax:
Practice Address - Street 1:1530 FOREST HILLS DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4449
Practice Address - Country:US
Practice Address - Phone:605-388-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0275225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist