Healthcare Provider Details

I. General information

NPI: 1750057048
Provider Name (Legal Business Name): REECE MCCART DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 N LINE ST
COLUMBIA CITY IN
46725-1254
US

IV. Provider business mailing address

4251 LAHMEYER RD
FORT WAYNE IN
46815-5676
US

V. Phone/Fax

Practice location:
  • Phone: 260-702-0400
  • Fax:
Mailing address:
  • Phone: 260-432-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05014344A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: