Provider Demographics
NPI:1740883206
Name:REICHENBERGER, KATHLEEN MICHELLE
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MICHELLE
Last Name:REICHENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 S HILLRISE DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4617
Mailing Address - Country:US
Mailing Address - Phone:909-802-3773
Mailing Address - Fax:
Practice Address - Street 1:2745 S HILLRISE DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4617
Practice Address - Country:US
Practice Address - Phone:909-802-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic