Provider Demographics
NPI:1104872613
Name:REITMAN PHYSICAL THERAPY
Entity type:Organization
Organization Name:REITMAN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:KIT
Authorized Official - Middle Name:
Authorized Official - Last Name:REITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:650-328-2250
Mailing Address - Street 1:885 OAK GROVE AVE
Mailing Address - Street 2:STE. 101
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4433
Mailing Address - Country:US
Mailing Address - Phone:650-328-2250
Mailing Address - Fax:650-328-2256
Practice Address - Street 1:885 OAK GROVE AVE
Practice Address - Street 2:STE. 101
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4433
Practice Address - Country:US
Practice Address - Phone:650-328-2250
Practice Address - Fax:650-328-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ55368ZOtherBLUE SHIELD
CAZZZ21038ZMedicare ID - Type Unspecified