Healthcare Provider Details

I. General information

NPI: 1376403568
Provider Name (Legal Business Name): JENESSA REINART PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3071 E FRANKLIN RD # 303
MERIDIAN ID
83642-2376
US

IV. Provider business mailing address

18318 VICEROY AVE
NAMPA ID
83687-8199
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-3334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTA-9010
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: