Provider Demographics
NPI:1245660208
Name:REIBER, ELAINE
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:REIBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7495 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-9451
Mailing Address - Country:US
Mailing Address - Phone:989-845-7455
Mailing Address - Fax:
Practice Address - Street 1:5211 MARSH RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1106
Practice Address - Country:US
Practice Address - Phone:517-319-1383
Practice Address - Fax:517-318-0258
Is Sole Proprietor?:No
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2249504225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant