Provider Demographics
NPI:1164002671
Name:REUL, MILDRED JEAN (RPT,MS)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:JEAN
Last Name:REUL
Suffix:
Gender:F
Credentials:RPT,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57616 INTERLACHEN
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-5052
Mailing Address - Country:US
Mailing Address - Phone:760-219-3312
Mailing Address - Fax:
Practice Address - Street 1:57616 INTERLACHEN
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-5052
Practice Address - Country:US
Practice Address - Phone:760-219-3312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist