Provider Demographics
NPI:1851583488
Name:REINHARDT, MATHIAS LORENZ
Entity Type:Individual
Prefix:MR
First Name:MATHIAS
Middle Name:LORENZ
Last Name:REINHARDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13002 SE 188TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-7910
Mailing Address - Country:US
Mailing Address - Phone:425-793-4052
Mailing Address - Fax:425-793-4052
Practice Address - Street 1:13002 SE 188TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-7910
Practice Address - Country:US
Practice Address - Phone:425-793-4052
Practice Address - Fax:425-793-4052
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA015794171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0151913OtherL&I