Provider Demographics
NPI:1245295146
Name:REENDERS, DAVID WILLIAM (RPT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WILLIAM
Last Name:REENDERS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:647 CAMINO DE LOS MARES
Mailing Address - Street 2:#111
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2825
Mailing Address - Country:US
Mailing Address - Phone:949-240-0600
Mailing Address - Fax:949-240-7578
Practice Address - Street 1:647 CAMINO DE LOS MARES
Practice Address - Street 2:#111
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2825
Practice Address - Country:US
Practice Address - Phone:949-240-0600
Practice Address - Fax:949-240-7578
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 9681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17972Medicare ID - Type UnspecifiedPHYSICAL THERAPY