Provider Demographics
NPI:1396151890
Name:REINHARDT, MICHELLE RENE' (BSBA, MMP, LMT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RENE'
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:BSBA, MMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11010 S TOMAH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-1914
Mailing Address - Country:US
Mailing Address - Phone:480-447-9665
Mailing Address - Fax:
Practice Address - Street 1:11010 S TOMAH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-1914
Practice Address - Country:US
Practice Address - Phone:602-329-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-17462174400000X, 175T00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty