Healthcare Provider Details

I. General information

NPI: 1619166683
Provider Name (Legal Business Name): MICHELLE ANNE REININK D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 07/21/2022
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 AMERICAN BLVD W
BLOOMINGTON MN
55431-4420
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-831-8742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501015932
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: