Provider Demographics
NPI:1083200844
Name:REIB, LARRY DAVID (CO)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:DAVID
Last Name:REIB
Suffix:
Gender:M
Credentials:CO
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Mailing Address - Street 1:4811 CHIPPENDALE DRIVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-2251
Mailing Address - Country:US
Mailing Address - Phone:916-595-1310
Mailing Address - Fax:916-344-8045
Practice Address - Street 1:4811 CHIPPENDALE DRIVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-2251
Practice Address - Country:US
Practice Address - Phone:916-595-1310
Practice Address - Fax:916-344-8045
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO001506222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist