Provider Demographics
NPI:1063945236
Name:REICHERT, CARLYE (DO)
Entity type:Individual
Prefix:DR
First Name:CARLYE
Middle Name:
Last Name:REICHERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARLYE
Other - Middle Name:
Other - Last Name:MARSZALEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 NEENAH CTR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3070
Mailing Address - Country:US
Mailing Address - Phone:920-831-5050
Mailing Address - Fax:920-729-2104
Practice Address - Street 1:200 THEDA CLARK MEDICAL PLZ STE 240
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2790
Practice Address - Country:US
Practice Address - Phone:920-831-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017021948208100000X, 208100000X
WI75673208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation