MEDICARE: MR. DONALD KIRK REORDAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225100000X	Physical Therapist	02649	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194717165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD KIRK REORDAN PT

Provider Business Mailing Address
First Line	:	635 N. 5TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	OR
Zip	:	97530
Country	:	US
Telephone Number	:	541-899-8179
Fax Number	:	541-899-0244

Provider Business Practice Location Address
First Line	:	635 N. 5TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	OR
Zip	:	97530
Country	:	US
Telephone Number	:	541-899-8179
Fax Number	:	541-899-0244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	03/10/2020

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