Healthcare Provider Details

I. General information

NPI: 1255054102
Provider Name (Legal Business Name): BARRETT ROBERT REIF DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N NORTHWOOD CENTER CT STE 101
COEUR D ALENE ID
83814-6190
US

IV. Provider business mailing address

1233 N NORTHWOOD CENTER CT STE 101
COEUR D ALENE ID
83814-6190
US

V. Phone/Fax

Practice location:
  • Phone: 208-215-2450
  • Fax: 208-773-1473
Mailing address:
  • Phone: 208-215-2450
  • Fax: 208-773-1473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12628
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9171049
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: