Healthcare Provider Details

I. General information

NPI: 1396151890
Provider Name (Legal Business Name): MICHELLE RENE' REINHARDT BSBA, MMP, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11010 S TOMAH ST
PHOENIX AZ
85044-1914
US

IV. Provider business mailing address

11010 S TOMAH ST
PHOENIX AZ
85044-1914
US

V. Phone/Fax

Practice location:
  • Phone: 602-329-8585
  • Fax:
Mailing address:
  • Phone: 480-447-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT-17462
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMT-17462
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-17462
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: