Provider Demographics
NPI:1831240027
Name:REIMER, TRACEY J (P T)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:J
Last Name:REIMER
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:J
Other - Last Name:REIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6000 N ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-3294
Mailing Address - Country:US
Mailing Address - Phone:309-691-1400
Mailing Address - Fax:309-693-3197
Practice Address - Street 1:2351 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3972
Practice Address - Country:US
Practice Address - Phone:309-353-5940
Practice Address - Fax:309-353-1654
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0029040315OtherIL BLUE CROSS BLUE SHIELD
IL11373584OtherCAQH PROVIDER ID
P00094223OtherRAILROAD PIN NUMBER
ILL86868Medicare PIN