Provider Demographics
NPI:1316642291
Name:REIDLINGER, JACOB C
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:C
Last Name:REIDLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 SHADY VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28610-9557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2030 HARPER AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4953
Practice Address - Country:US
Practice Address - Phone:828-754-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7268225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant