Provider Demographics
NPI:1386825693
Name:REIS, ANN CHRISTINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:CHRISTINE
Last Name:REIS
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 1:4531 MAINE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-5872
Mailing Address - Country:US
Mailing Address - Phone:217-228-2853
Mailing Address - Fax:217-228-2868
Practice Address - Street 1:4531 MAINE ST
Practice Address - Street 2:SUITE C
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5872
Practice Address - Country:US
Practice Address - Phone:217-228-2853
Practice Address - Fax:217-228-2868
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist