Provider Demographics
NPI:1861593154
Name:REICHENBERGER, DAVID JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:REICHENBERGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N OAK AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-0372
Mailing Address - Country:US
Mailing Address - Phone:715-389-0636
Mailing Address - Fax:
Practice Address - Street 1:98 SHERRY AVE
Practice Address - Street 2:
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-1467
Practice Address - Country:US
Practice Address - Phone:715-762-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1385-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist