MEDICARE: TRACEY REINECKE

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	004051	KY

General Provider Information

NPI Number	:	1578165890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY REINECKE

Provider Business Mailing Address
First Line	:	3614 BREELAND AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-2604
Country	:	US
Telephone Number	:	502-541-5641
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 ARNOLD PALMER BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-3222
Country	:	US
Telephone Number	:	502-541-5641
Fax Number	:

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

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	11/11/2020

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Directions to “ TRACEY REINECKE ” Practice Location

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