Provider Demographics
NPI:1053703025
Name:RIEBER, CARLENE (PT, DPT)
Entity type:Individual
Prefix:
First Name:CARLENE
Middle Name:
Last Name:RIEBER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 TESCONI CIR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4676
Mailing Address - Country:US
Mailing Address - Phone:707-546-9160
Mailing Address - Fax:707-546-1338
Practice Address - Street 1:340 TESCONI CIR
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4676
Practice Address - Country:US
Practice Address - Phone:707-546-9160
Practice Address - Fax:707-546-1338
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42095225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist