Provider Demographics
NPI:1619552635
Name:REICHLE, SETOUDEH STELLA (MT, MI)
Entity Type:Individual
Prefix:
First Name:SETOUDEH STELLA
Middle Name:
Last Name:REICHLE
Suffix:
Gender:F
Credentials:MT, MI
Other - Prefix:
Other - First Name:S STELLA
Other - Middle Name:
Other - Last Name:REICHLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT, MI
Mailing Address - Street 1:4304 LAGUNA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4013
Mailing Address - Country:US
Mailing Address - Phone:214-494-9642
Mailing Address - Fax:
Practice Address - Street 1:4304 LAGUNA DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-4013
Practice Address - Country:US
Practice Address - Phone:214-494-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT018043225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist