Provider Demographics
NPI:1245879105
Name:REINKING, SKYE PAULY (PT)
Entity type:Individual
Prefix:
First Name:SKYE
Middle Name:PAULY
Last Name:REINKING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SKYE
Other - Middle Name:ALISA
Other - Last Name:PAULY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 7063
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-7063
Mailing Address - Country:US
Mailing Address - Phone:509-393-0886
Mailing Address - Fax:
Practice Address - Street 1:245 RAVEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-726-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-24
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-84972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic