Provider Demographics
NPI:1730107137
Name:REESE,, DAVID E III (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:REESE,
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 PEBBLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9455
Mailing Address - Country:US
Mailing Address - Phone:319-665-2992
Mailing Address - Fax:
Practice Address - Street 1:455 PEBBLE ST
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-9455
Practice Address - Country:US
Practice Address - Phone:319-665-2992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02941208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00064241OtherRAILROAD MEDICARE
IA44321OtherWELLMARK BCBS
IA0429019Medicaid
IAF232553OtherMIDLANDS CHOICE
IAP00064241OtherRAILROAD MEDICARE