Provider Demographics
NPI:1154400943
Name:REINBOLD, DUSTIN JAMES (PT)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JAMES
Last Name:REINBOLD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2150
Mailing Address - Country:US
Mailing Address - Phone:402-434-5905
Mailing Address - Fax:
Practice Address - Street 1:5633 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4465
Practice Address - Country:US
Practice Address - Phone:402-434-5905
Practice Address - Fax:402-434-5902
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03154225100000X
NE2520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0488759Medicaid
IA38762OtherBC/BS
IAI17408Medicare ID - Type Unspecified