Provider Demographics
NPI:1598455057
Name:REINHARDT, GLENNA (LO)
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:LO
Other - Prefix:
Other - First Name:GLENNA
Other - Middle Name:
Other - Last Name:KOZAREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6432 WILRYAN AVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1446
Mailing Address - Country:US
Mailing Address - Phone:612-889-0973
Mailing Address - Fax:
Practice Address - Street 1:6600 FRANCE AVE S STE 164
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1802
Practice Address - Country:US
Practice Address - Phone:612-889-0973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1048222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist