Provider Demographics
NPI:1639658818
Name:DECKER, JOHN REINHOLD (RPT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:REINHOLD
Last Name:DECKER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46507 LORRAINE CIR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033-6937
Mailing Address - Country:US
Mailing Address - Phone:605-366-1002
Mailing Address - Fax:605-322-7740
Practice Address - Street 1:46507 LORRAINE CIR
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:SD
Practice Address - Zip Code:57033-6937
Practice Address - Country:US
Practice Address - Phone:605-366-1002
Practice Address - Fax:605-322-7740
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist