Provider Demographics
NPI:1912736067
Name:REISZ, WILLIAM BENJAMIN (ATC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BENJAMIN
Last Name:REISZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5008
Mailing Address - Country:US
Mailing Address - Phone:443-286-5104
Mailing Address - Fax:
Practice Address - Street 1:THOMPSON ATHLETIC CENTER 3700 O ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20057-0001
Practice Address - Country:US
Practice Address - Phone:443-286-5104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00010512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer