Provider Demographics
NPI:1295251866
Name:REICKS, TAYLOR J (DPT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:J
Last Name:REICKS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-3416
Mailing Address - Country:US
Mailing Address - Phone:406-222-4682
Mailing Address - Fax:
Practice Address - Street 1:315 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3416
Practice Address - Country:US
Practice Address - Phone:406-222-4682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60763666225100000X
MTPTP-PT-LIC-19347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist