Provider Demographics
NPI:1710520002
Name:REICHLE, RAEVYN N (LMT)
Entity Type:Individual
Prefix:MS
First Name:RAEVYN
Middle Name:N
Last Name:REICHLE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:RAEVYN
Other - Middle Name:N
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:614 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75683-2515
Mailing Address - Country:US
Mailing Address - Phone:903-720-1571
Mailing Address - Fax:
Practice Address - Street 1:208 N FREDONIA ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-7209
Practice Address - Country:US
Practice Address - Phone:903-230-1911
Practice Address - Fax:903-230-1900
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT127156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist