Provider Demographics
NPI:1891246856
Name:REINERT, MELISSA (LAT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:REINERT
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CONNER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105-1423
Mailing Address - Country:US
Mailing Address - Phone:817-814-0086
Mailing Address - Fax:817-814-0050
Practice Address - Street 1:1300 CONNER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105-1423
Practice Address - Country:US
Practice Address - Phone:817-814-0086
Practice Address - Fax:817-814-0050
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT2343225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist