Provider Demographics
NPI:1740069491
Name:REINSCH, KELLEN XAVIER (ATC, LAT)
Entity type:Individual
Prefix:
First Name:KELLEN
Middle Name:XAVIER
Last Name:REINSCH
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 GRUNDMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-3397
Mailing Address - Country:US
Mailing Address - Phone:402-873-7411
Mailing Address - Fax:
Practice Address - Street 1:1104 GRUNDMAN BLVD
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-3397
Practice Address - Country:US
Practice Address - Phone:402-873-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer