Provider Demographics
NPI:1659610186
Name:REIGHARD, SHANALYN MICHELLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SHANALYN
Middle Name:MICHELLE
Last Name:REIGHARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CHIPMUNK LANE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537
Mailing Address - Country:US
Mailing Address - Phone:814-652-0122
Mailing Address - Fax:
Practice Address - Street 1:9709 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-3717
Practice Address - Country:US
Practice Address - Phone:814-652-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225200000X
MDA3714225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant