Provider Demographics
NPI:1174819304
Name:REICH, JAIME L (PT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:L
Last Name:REICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 S WHITNEY WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4656
Mailing Address - Country:US
Mailing Address - Phone:608-238-1312
Mailing Address - Fax:608-238-1464
Practice Address - Street 1:340 S WHITNEY WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4656
Practice Address - Country:US
Practice Address - Phone:608-238-1312
Practice Address - Fax:608-238-1464
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11709-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist