Provider Demographics
NPI:1033976691
Name:REECE, MICHAEL LEO (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEO
Last Name:REECE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 DELL TRL
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-5511
Mailing Address - Country:US
Mailing Address - Phone:423-949-4651
Mailing Address - Fax:423-949-4652
Practice Address - Street 1:360 DELL TRL
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-5511
Practice Address - Country:US
Practice Address - Phone:423-949-4652
Practice Address - Fax:423-949-4652
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2180225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant