Provider Demographics
NPI:1417035619
Name:REINHOLZ, JOHN PAUL SR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:REINHOLZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DANNENBURG RD
Mailing Address - Street 2:REINHOLZ CUSTOM FOOTWEAR
Mailing Address - City:MOLT
Mailing Address - State:MT
Mailing Address - Zip Code:59057-2244
Mailing Address - Country:US
Mailing Address - Phone:406-669-3222
Mailing Address - Fax:
Practice Address - Street 1:100 DANNENBURG RD
Practice Address - Street 2:REINHOLZ CUSTOM FOOTWEAR
Practice Address - City:MOLT
Practice Address - State:MT
Practice Address - Zip Code:59057-2244
Practice Address - Country:US
Practice Address - Phone:406-669-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5601942Medicaid
MT5601942Medicaid