Healthcare Provider Details

I. General information

NPI: 1861411928
Provider Name (Legal Business Name): TRACEY MARIE REINOEHL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HARBERT DR SUITE B
DAYTON OH
45440
US

IV. Provider business mailing address

4801 SPRINGFIELD ST
RIVERSIDE OH
45431-1084
US

V. Phone/Fax

Practice location:
  • Phone: 937-427-1919
  • Fax: 937-427-1949
Mailing address:
  • Phone: 937-236-9965
  • Fax: 937-233-0161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9408PT
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: