Provider Demographics
NPI:1245226158
Name:SCHONHOFF-REITER, KIM MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MARIE
Last Name:SCHONHOFF-REITER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:SCHONHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2010 E RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-2730
Mailing Address - Country:US
Mailing Address - Phone:319-233-3010
Mailing Address - Fax:319-233-3919
Practice Address - Street 1:2010 E RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-2730
Practice Address - Country:US
Practice Address - Phone:319-233-3010
Practice Address - Fax:319-233-3919
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA58089OtherWELLMARK BC/BS OF IOWA
IAI18749Medicare PIN