Provider Demographics
NPI:1558521153
Name:REASNER, MICHAEL GARNET (PTA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GARNET
Last Name:REASNER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7733 FORSYTH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1817
Mailing Address - Country:US
Mailing Address - Phone:180-067-7123
Mailing Address - Fax:
Practice Address - Street 1:17201 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-5129
Practice Address - Country:US
Practice Address - Phone:206-364-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19457314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility