Provider Demographics
NPI:1013933613
Name:REEKSTIN, MATTHEW J (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:REEKSTIN
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 1:1125 CERRITOS DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4019
Mailing Address - Country:US
Mailing Address - Phone:714-449-9965
Mailing Address - Fax:
Practice Address - Street 1:1027 N HARBOR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1310
Practice Address - Country:US
Practice Address - Phone:714-870-8478
Practice Address - Fax:714-870-8405
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT26462AOtherPPIN
CAP79420Medicare UPIN
CAPT26462Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAWPT26462AOtherPPIN