Provider Demographics
NPI:1356371603
Name:REINHARDT, PETER DANIEL
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:DANIEL
Last Name:REINHARDT
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 1:4190 DOUGLASS WAY
Mailing Address - Street 2:
Mailing Address - City:U S A F ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-1009
Mailing Address - Country:US
Mailing Address - Phone:719-964-5060
Mailing Address - Fax:
Practice Address - Street 1:338 S DAKOTA AVE
Practice Address - Street 2:BLDG 13850
Practice Address - City:VANDENBERG AFB
Practice Address - State:CA
Practice Address - Zip Code:93437-6307
Practice Address - Country:US
Practice Address - Phone:805-606-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.055206225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist