Provider Demographics
NPI:1346879160
Name:REID, NANETTE F (PT)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:F
Last Name:REID
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 1:103 WEST 1450 NORTH
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014
Mailing Address - Country:US
Mailing Address - Phone:801-554-3572
Mailing Address - Fax:
Practice Address - Street 1:103 WEST 1450 NORTH
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014
Practice Address - Country:US
Practice Address - Phone:801-554-3572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT118943-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist