Provider Demographics
NPI:1598057606
Name:REINTJES, HENDRIKA GRADA (PT)
Entity Type:Individual
Prefix:
First Name:HENDRIKA
Middle Name:GRADA
Last Name:REINTJES
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 1:733 DUNLAWTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4225
Mailing Address - Country:US
Mailing Address - Phone:386-756-0077
Mailing Address - Fax:386-756-6811
Practice Address - Street 1:733 DUNLAWTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4225
Practice Address - Country:US
Practice Address - Phone:386-756-0077
Practice Address - Fax:386-756-6811
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-07
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist