Provider Demographics
NPI:1801091277
Name:REISINGER, MICHELLE DENISE (LMT)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:DENISE
Last Name:REISINGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 STEEPLECHASE LN
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-4004
Mailing Address - Country:US
Mailing Address - Phone:931-624-4333
Mailing Address - Fax:
Practice Address - Street 1:1820 MADISON ST STE D
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8037
Practice Address - Country:US
Practice Address - Phone:931-624-4333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK127526225700000X
TN10420225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK127526OtherLMT
TN10420OtherLMT