Provider Demographics
NPI:1194717165
Name:REORDAN, DONALD KIRK (PT)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:KIRK
Last Name:REORDAN
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 1:635 N. 5TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530
Mailing Address - Country:US
Mailing Address - Phone:541-899-8179
Mailing Address - Fax:541-899-0244
Practice Address - Street 1:635 N. 5TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530
Practice Address - Country:US
Practice Address - Phone:541-899-8179
Practice Address - Fax:541-899-0244
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
OR02649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR158389Medicaid
OR158389Medicaid