Healthcare Provider Details

I. General information

NPI: 1225326754
Provider Name (Legal Business Name): BLAKE DAVID REINKE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 18TH ST
SPIRIT LAKE IA
51360-1014
US

IV. Provider business mailing address

PO BOX 921
LE MARS IA
51031-0921
US

V. Phone/Fax

Practice location:
  • Phone: 712-546-1718
  • Fax:
Mailing address:
  • Phone: 712-546-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number004814
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: