Healthcare Provider Details

I. General information

NPI: 1215143524
Provider Name (Legal Business Name): DEBRA R REICHL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTER FOR BLIND AND VISUALLY IMPAIRED CHILDREN 5600 W BROWN DEER RD, STE. 4
MILWAUKEE WI
53223
US

IV. Provider business mailing address

704 N PONDEROSA DR
HARTLAND WI
53029-8640
US

V. Phone/Fax

Practice location:
  • Phone: 414-365-3060
  • Fax: 414-355-3547
Mailing address:
  • Phone: 262-369-9371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: