Provider Demographics
NPI:1477171437
Name:REICH, KARA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MARIE
Last Name:REICH
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 1:1670 ROBERT ST S # 250
Mailing Address - Street 2:
Mailing Address - City:WEST SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3918
Mailing Address - Country:US
Mailing Address - Phone:612-600-4125
Mailing Address - Fax:
Practice Address - Street 1:2108 BROADWAY ST S
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-3951
Practice Address - Country:US
Practice Address - Phone:715-953-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11893225100000X
WI1514724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist