Provider Demographics
NPI:1942459169
Name:REINART, CARSON ILMAR (DPT)
Entity Type:Individual
Prefix:DR
First Name:CARSON
Middle Name:ILMAR
Last Name:REINART
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1524
Mailing Address - Country:US
Mailing Address - Phone:413-732-3406
Mailing Address - Fax:413-732-5469
Practice Address - Street 1:74 WALNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1524
Practice Address - Country:US
Practice Address - Phone:413-732-3406
Practice Address - Fax:413-732-5469
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA91112251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics