Provider Demographics
NPI:1053373340
Name:REINHOLD, ERIC (MPT, ATC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:REINHOLD
Suffix:
Gender:M
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SAVANNAH RD
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1550
Mailing Address - Country:US
Mailing Address - Phone:302-644-2530
Mailing Address - Fax:302-644-2556
Practice Address - Street 1:701 SAVANNAH RD
Practice Address - Street 2:SUITE A-1
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1550
Practice Address - Country:US
Practice Address - Phone:302-644-2530
Practice Address - Fax:302-644-2556
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001293225100000X
DEJ3-00001402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE010356S11Medicare ID - Type Unspecified