Provider Demographics
NPI:1629238720
Name:REINECKER, ADAM (DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:REINECKER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16265 NW CORNELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4909
Mailing Address - Country:US
Mailing Address - Phone:503-466-9800
Mailing Address - Fax:503-466-9817
Practice Address - Street 1:16265 NW CORNELL RD STE 100
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4909
Practice Address - Country:US
Practice Address - Phone:503-466-9800
Practice Address - Fax:503-466-9817
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR142157Medicare PIN
ORR130647Medicare PIN
ORR114556Medicare PIN
ORR142640Medicare PIN
ORR114778Medicare PIN
ORR143327Medicare PIN
ORR114519Medicare PIN
ORR142641Medicare PIN