Provider Demographics
NPI:1245269703
Name:RINEHART, WADE M (PT)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:M
Last Name:RINEHART
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 1:2300 JENKS AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4798
Mailing Address - Country:US
Mailing Address - Phone:850-248-1600
Mailing Address - Fax:850-248-1602
Practice Address - Street 1:2300 JENKS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4798
Practice Address - Country:US
Practice Address - Phone:850-248-1600
Practice Address - Fax:850-248-1602
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT184112251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4132Medicare PIN
FLY8459ZMedicare PIN
FLY035KZMedicare PIN