Provider Demographics
NPI:1770630295
Name:REINERTSON, MATTHEW SCOTT (ATC, OTC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:REINERTSON
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Gender:M
Credentials:ATC, OTC
Other - Prefix:
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Mailing Address - Street 1:111 17TH AVE E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-3734
Mailing Address - Country:US
Mailing Address - Phone:320-762-1144
Mailing Address - Fax:320-762-1935
Practice Address - Street 1:2800 1ST STREET SOUTH
Practice Address - Street 2:STE 220
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3556
Practice Address - Country:US
Practice Address - Phone:320-214-7355
Practice Address - Fax:320-214-7356
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2014-04-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN10772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer