Provider Demographics
NPI:1528064250
Name:REISTER, MICHAEL T (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:REISTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2587 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:VILLA HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1056
Mailing Address - Country:US
Mailing Address - Phone:859-344-8663
Mailing Address - Fax:
Practice Address - Street 1:1400 GLORIA TERRELL DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41076-9189
Practice Address - Country:US
Practice Address - Phone:859-781-2800
Practice Address - Fax:859-781-3500
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY003561208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8700077400Medicaid
KY5017107Medicare PIN
KY0667004Medicare PIN