Provider Demographics
NPI:1447219845
Name:REIN, WILLIAM JACK (MPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JACK
Last Name:REIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 E ENTERPRISE AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7862
Mailing Address - Country:US
Mailing Address - Phone:920-560-1147
Mailing Address - Fax:920-560-1197
Practice Address - Street 1:1640 N CASALOMA DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8245
Practice Address - Country:US
Practice Address - Phone:920-560-1147
Practice Address - Fax:920-560-1197
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10528024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist