Provider Demographics
NPI:1053733436
Name:NOLA, REINE (DPT)
Entity type:Individual
Prefix:
First Name:REINE
Middle Name:
Last Name:NOLA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2501
Mailing Address - Country:US
Mailing Address - Phone:316-304-1924
Mailing Address - Fax:
Practice Address - Street 1:804 S OLIVER AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2329
Practice Address - Country:US
Practice Address - Phone:316-779-4110
Practice Address - Fax:316-330-7019
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1104627225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist