Healthcare Provider Details

I. General information

NPI: 1326012568
Provider Name (Legal Business Name): MARK F REINKING PT, SCS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 REGIS BLVD G-4
DENVER CO
80221-1154
US

IV. Provider business mailing address

3372 W 38TH AVE APT 312
DENVER CO
80211-1963
US

V. Phone/Fax

Practice location:
  • Phone: 303-964-6471
  • Fax:
Mailing address:
  • Phone: 314-680-3923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number119734
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number119807
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: