Provider Demographics
NPI:1194720094
Name:REIFF, TODD ALAN (PT)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:ALAN
Last Name:REIFF
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 1:2706 USHER ST
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-3939
Mailing Address - Country:US
Mailing Address - Phone:574-722-5352
Mailing Address - Fax:
Practice Address - Street 1:1603 CHASE RD
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1538
Practice Address - Country:US
Practice Address - Phone:574-737-7404
Practice Address - Fax:574-737-7503
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002431A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000178981OtherANTHEM BLUE CROSS
IN156544Medicare ID - Type Unspecified