Provider Demographics
NPI:1740588268
Name:REISNER, JACQUELINE (DPT)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:REISNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S BEDFORD RD STE 109
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3452
Mailing Address - Country:US
Mailing Address - Phone:212-241-8000
Mailing Address - Fax:914-241-3547
Practice Address - Street 1:103 S BEDFORD RD STE 109
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3452
Practice Address - Country:US
Practice Address - Phone:212-241-8000
Practice Address - Fax:914-241-3547
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034572-1225100000X
NJ40QA01388400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist