Provider Demographics
NPI:1861862344
Name:REINKE, MAXIMILIAN (PT)
Entity Type:Individual
Prefix:
First Name:MAXIMILIAN
Middle Name:
Last Name:REINKE
Suffix:
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 1:4709 GOLF RD
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1231
Mailing Address - Country:US
Mailing Address - Phone:847-869-7233
Mailing Address - Fax:847-869-9461
Practice Address - Street 1:4709 GOLF RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1231
Practice Address - Country:US
Practice Address - Phone:847-869-7233
Practice Address - Fax:847-869-9461
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-021825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist