Provider Demographics
NPI:1891868303
Name:REISCHMANN, PHYLLIS L (PT)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:L
Last Name:REISCHMANN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 MOTOR PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5260
Mailing Address - Country:US
Mailing Address - Phone:631-582-0088
Mailing Address - Fax:631-582-0405
Practice Address - Street 1:1770 MOTOR PKWY STE 202
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11749-5260
Practice Address - Country:US
Practice Address - Phone:631-582-0088
Practice Address - Fax:631-582-0405
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0078991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ18J82Medicare ID - Type UnspecifiedMEDICARE