Provider Demographics
NPI:1245208313
Name:REIMHOLZ, BRENT ERIC (ATC)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:ERIC
Last Name:REIMHOLZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2894 FALLING WATERS LN
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6779
Mailing Address - Country:US
Mailing Address - Phone:630-928-3400
Mailing Address - Fax:847-465-8365
Practice Address - Street 1:481 E DUNDEE RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3121
Practice Address - Country:US
Practice Address - Phone:847-465-0355
Practice Address - Fax:847-465-8365
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist