Provider Demographics
NPI:1063432029
Name:REIS, THOMAS WESLEY (CP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WESLEY
Last Name:REIS
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5460 MERLE HAY RD STE C
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1239
Mailing Address - Country:US
Mailing Address - Phone:515-254-0244
Mailing Address - Fax:515-254-0309
Practice Address - Street 1:5460 MERLE HAY RD STE C
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1239
Practice Address - Country:US
Practice Address - Phone:515-254-0244
Practice Address - Fax:515-254-0309
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IACP-1182174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist