Provider Demographics
NPI:1750531901
Name:GERVILLE-REACHE, LOIC MAXIME (PT)
Entity type:Individual
Prefix:
First Name:LOIC
Middle Name:MAXIME
Last Name:GERVILLE-REACHE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 KELLEY DR
Mailing Address - Street 2:STE 101
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5819
Mailing Address - Country:US
Mailing Address - Phone:731-641-0002
Mailing Address - Fax:731-641-0030
Practice Address - Street 1:1015 KELLEY DR
Practice Address - Street 2:STE 101
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5819
Practice Address - Country:US
Practice Address - Phone:731-641-0002
Practice Address - Fax:731-641-0030
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist