Provider Demographics
NPI:1043430887
Name:RECONNECTIONS INCORPORATED
Entity Type:Organization
Organization Name:RECONNECTIONS INCORPORATED
Other - Org Name:MYO REHAB THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:425-822-6433
Mailing Address - Street 1:826 6TH ST S
Mailing Address - Street 2:STE 100
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6714
Mailing Address - Country:US
Mailing Address - Phone:425-822-6433
Mailing Address - Fax:425-827-5462
Practice Address - Street 1:826 6TH ST S
Practice Address - Street 2:STE 100
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6714
Practice Address - Country:US
Practice Address - Phone:425-822-6433
Practice Address - Fax:425-827-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6007224151OtherMASTER LICENSE NUMBER