Provider Demographics
NPI:1467674119
Name:REICHMANN, JANE B (PT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:B
Last Name:REICHMANN
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 1:1350 E 1ST SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-2517
Mailing Address - Country:US
Mailing Address - Phone:217-854-6057
Mailing Address - Fax:217-854-9820
Practice Address - Street 1:20733 N BROAD ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-3710
Practice Address - Country:US
Practice Address - Phone:217-854-3141
Practice Address - Fax:217-854-9820
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJR5057898P222Q00000X
IL070-002719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1053425124OtherHOSPITAL