Provider Demographics
NPI:1619280989
Name:REICHE, MEGAN A (DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:REICHE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:A
Other - Last Name:KENNEBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:781 S MCHENRY AVE
Practice Address - Street 2:STUITE C
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7444
Practice Address - Country:US
Practice Address - Phone:815-455-7800
Practice Address - Fax:815-455-1299
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist