Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 07532 | OH |
NPI | 1013236470 |
---|---|
Provider Name | Jason Patrick Reichel |
First Address | Wilton, CT 06897-4429 |
Second Address | Elizabethtown, KY 42701-2774 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2010 |
Last Update Date | 25/05/2010 |