MEDICARE: MR. PETER DANIEL REINHARDT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	056.055206	IL

General Provider Information

NPI Number	:	1356371603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER DANIEL REINHARDT

Provider Business Mailing Address
First Line	:	4190 DOUGLASS WAY
Second Line	:
City	:	U S A F ACADEMY
State	:	CO
Zip	:	80840-1009
Country	:	US
Telephone Number	:	719-964-5060
Fax Number	:

Provider Business Practice Location Address
First Line	:	338 S DAKOTA AVE
Second Line	:	BLDG 13850
City	:	VANDENBERG AFB
State	:	CA
Zip	:	93437-6307
Country	:	US
Telephone Number	:	805-606-2221
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	05/24/2011

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