Provider Demographics
NPI:1528457058
Name:REIKOWSKI, SAMANTHA
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:REIKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 E HILLIS RD
Mailing Address - Street 2:
Mailing Address - City:VESTABURG
Mailing Address - State:MI
Mailing Address - Zip Code:48891-9726
Mailing Address - Country:US
Mailing Address - Phone:989-280-7614
Mailing Address - Fax:
Practice Address - Street 1:9300 E HILLIS RD
Practice Address - Street 2:
Practice Address - City:VESTABURG
Practice Address - State:MI
Practice Address - Zip Code:48891-9726
Practice Address - Country:US
Practice Address - Phone:989-280-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004090225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant