MEDICARE: ERIC CHRISTIAN REICHARDT M.P.T.

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	2305201815	VA

General Provider Information

NPI Number	:	1770689788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC CHRISTIAN REICHARDT M.P.T.

Provider Business Mailing Address
First Line	:	PO BOX 8763
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-0732
Country	:	US
Telephone Number	:	540-985-6500
Fax Number	:	540-985-6501

Provider Business Practice Location Address
First Line	:	1310 3RD ST SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24016-5219
Country	:	US
Telephone Number	:	540-985-6500
Fax Number	:	540-985-6501

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	01/05/2022

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