Healthcare Provider Details

I. General information

NPI: 1336079953
Provider Name (Legal Business Name): JUSTIN ALLEN REITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2026
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4819 ALBERTLY AVE
PARMA OH
44134-3323
US

IV. Provider business mailing address

20377 WILLIAMSBURG CT # 223D
CLEVELAND OH
44130-2450
US

V. Phone/Fax

Practice location:
  • Phone: 330-523-6967
  • Fax:
Mailing address:
  • Phone: 440-902-8743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: