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General NPI Number Information
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NPI Number | 1528064250
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Entity Type | Individual
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Provider Name | MICHAEL T REISTER P.T.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1400 GLORIA TERRELL DRIVE SUITE G
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City | WILDER
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State | KY
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Zip | 41076-9189
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Country | US
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Telephone | 859-781-2800
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Fax | 859-781-3500
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Provider Business Mailing Address
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Address Line | 2587 SIERRA DR
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City | VILLA HILLS
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State | KY
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Zip | 41017-1056
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Country | US
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Telephone | 859-344-8663
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 003561
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License Number State | KY
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