Provider Demographics
NPI:1992909519
Name:RINALDO, JACQUELYN F (PT)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:F
Last Name:RINALDO
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:PO BOX 4507
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47724-0507
Mailing Address - Country:US
Mailing Address - Phone:812-471-8630
Mailing Address - Fax:812-471-8640
Practice Address - Street 1:3600 FREDERICA ST
Practice Address - Street 2:SUITE A
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6981
Practice Address - Country:US
Practice Address - Phone:270-926-1774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0777105Medicare ID - Type Unspecified