Provider Demographics
NPI:1164523544
Name:REILING, MICHAEL SHAWN (PT, MS, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SHAWN
Last Name:REILING
Suffix:
Gender:M
Credentials:PT, MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 44TH ST
Mailing Address - Street 2:SUITE 10,000
Mailing Address - City:MARION
Mailing Address - State:IA
Mailing Address - Zip Code:52302-3846
Mailing Address - Country:US
Mailing Address - Phone:319-373-7311
Mailing Address - Fax:319-373-7313
Practice Address - Street 1:999 44TH ST
Practice Address - Street 2:SUITE 10,000
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3846
Practice Address - Country:US
Practice Address - Phone:319-373-7311
Practice Address - Fax:319-373-7313
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00407225100000X
IA03220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24147OtherBCBS
IA0231142Medicaid
IA24147OtherBCBS