Individual
DOUGLAS RIESCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
12936 SW 133RD TER, MIAMI, FL 33186-6951
(305) 323-5833
(305) 387-9332
Mailing address
12936 SW 133RD TER, MIAMI, FL 33186-6951
(305) 323-5833
(305) 387-9332
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT20541
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
889975400
—
FL
01
—
Y021MZ
MEDICARE
—
Enumeration date
09/22/2006
Last updated
12/02/2010
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