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General NPI Number Information
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NPI Number | 1326512583
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Entity Type | Individual
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Provider Name | JINNO E REINANTE PTA
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Gender | Male
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Dates
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Enumeration Date | 01/21/2019
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 12105 AMBASSADOR DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80921-3642
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Country | US
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Telephone | 800-335-1060
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Fax |
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Provider Business Mailing Address
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Address Line | 8317 SAINT LOUIS AVE
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City | SKOKIE
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State | IL
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Zip | 60076-2929
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Country | US
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Telephone | 618-560-3418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160008434
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License Number State | IL
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