Healthcare Provider Details

I. General information

NPI: 1245208313
Provider Name (Legal Business Name): BRENT ERIC REIMHOLZ ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 E DUNDEE RD
WHEELING IL
60090-3121
US

IV. Provider business mailing address

2894 FALLING WATERS LN
LINDENHURST IL
60046-6779
US

V. Phone/Fax

Practice location:
  • Phone: 847-465-0355
  • Fax: 847-465-8365
Mailing address:
  • Phone: 630-928-3400
  • Fax: 847-465-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: