Provider Demographics
NPI:1902266802
Name:REINKING, JULIE (MPM, LAT,ATC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:REINKING
Suffix:
Gender:F
Credentials:MPM, LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 N BAY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-9013
Mailing Address - Country:US
Mailing Address - Phone:260-413-0428
Mailing Address - Fax:
Practice Address - Street 1:2970 N BAY VIEW RD
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-9013
Practice Address - Country:US
Practice Address - Phone:260-413-0428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001984A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer