Provider Demographics
NPI:1447437835
Name:RIEBENSAHM, SVEN (PTA)
Entity type:Individual
Prefix:
First Name:SVEN
Middle Name:
Last Name:RIEBENSAHM
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SEACREST DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-3228
Mailing Address - Country:US
Mailing Address - Phone:386-631-0881
Mailing Address - Fax:
Practice Address - Street 1:80 PINNACLES DR BLDG B
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2323
Practice Address - Country:US
Practice Address - Phone:386-586-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21028225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant