Healthcare Provider Details

I. General information

NPI: 1467618108
Provider Name (Legal Business Name): MEGAN MARIE REISERT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8245 NORTHCREEK DR
CINCINNATI OH
45236-2283
US

IV. Provider business mailing address

4600 WESLEY AVE STE N
CINCINNATI OH
45212-2298
US

V. Phone/Fax

Practice location:
  • Phone: 513-745-4706
  • Fax: 513-891-1794
Mailing address:
  • Phone: 513-246-7000
  • Fax: 513-841-1580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012154
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: