Provider Demographics
NPI:1336777283
Name:REIFKE, COLEMAN
Entity Type:Individual
Prefix:
First Name:COLEMAN
Middle Name:
Last Name:REIFKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:NH
Mailing Address - Zip Code:03307-0914
Mailing Address - Country:US
Mailing Address - Phone:603-731-1473
Mailing Address - Fax:
Practice Address - Street 1:7413 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:NH
Practice Address - Zip Code:03307-0914
Practice Address - Country:US
Practice Address - Phone:603-731-1473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer