Basic Information
| Provider Information | |||||||||
| NPI: | 1467462614 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REICHLEY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 803 | ||||||||
| Address2: | 1195 HISEY AVENUE WOODSTOCK REHAB & FITNESS | ||||||||
| City: | WOODSTOCK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404597772 | ||||||||
| FaxNumber: | 5404597782 | ||||||||
| Practice Location | |||||||||
| Address1: | 1195 HISEY AVENUE | ||||||||
| Address2: | WOODSTOCK REHAB & FITNESS | ||||||||
| City: | WOODSTOCK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404597772 | ||||||||
| FaxNumber: | 5404597782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 07/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0105005306 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 195498 | 01 | ANTHEM | OTHER | 541974261 | 01 | COMERCIAL | OTHER | 2230258 | 01 | FIRST HEALTH | OTHER |