Provider Demographics
NPI:1801960570
Name:REIGSTAD, MARY LYNN (CMT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYNN
Last Name:REIGSTAD
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 19TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-5297
Mailing Address - Country:US
Mailing Address - Phone:320-222-4958
Mailing Address - Fax:
Practice Address - Street 1:412 19TH AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-5297
Practice Address - Country:US
Practice Address - Phone:320-222-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNONE NEEDEDOtherNONE