Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 4728-024 | WI |
Y | 2251G0304X | Physical Therapist - Geriatrics | 4728-024 | WI |
NPI | 1124212089 |
---|---|
Provider Name | Dr. Chrystal Jean Reichard |
First Address | Appleton, WI 54912-2759 |
Second Address | Appleton, WI 54911-3454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2007 |
Last Update Date | 11/09/2007 |