MEDICARE: GREGORY REICHHARDT M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	31969	CO

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	:	1790744084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY REICHHARDT M.D.

Provider Business Mailing Address
First Line	:	1517 16TH AVENUE CT
Second Line	:
City	:	GREELEY
State	:	CO
Zip	:	80631-4574
Country	:	US
Telephone Number	:	970-392-2490
Fax Number	:	970-392-2177

Provider Business Practice Location Address
First Line	:	1517 16TH AVENUE CT
Second Line	:
City	:	GREELEY
State	:	CO
Zip	:	80631-4574
Country	:	US
Telephone Number	:	970-392-2490
Fax Number	:	970-392-2177

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/08/2007

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