Healthcare Provider Details

I. General information

NPI: 1164736716
Provider Name (Legal Business Name): DONAVON L REIMCHE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 15TH ST
AUGUSTA GA
30912-0008
US

IV. Provider business mailing address

937 15TH ST
AUGUSTA GA
30912-0008
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2857
  • Fax: 706-721-3503
Mailing address:
  • Phone: 706-721-2857
  • Fax: 706-721-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License NumberPT002626
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT002626
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: