Provider Demographics
NPI:1861411928
Name:REINOEHL, TRACEY MARIE (PT)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:MARIE
Last Name:REINOEHL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1084
Mailing Address - Country:US
Mailing Address - Phone:937-236-9965
Mailing Address - Fax:937-233-0161
Practice Address - Street 1:115 HARBERT DR
Practice Address - Street 2:SUITE B
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440
Practice Address - Country:US
Practice Address - Phone:937-427-1919
Practice Address - Fax:937-427-1949
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH9408PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist