Basic Information
| Provider Information | |||||||||
| NPI: | 1851813083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REICHARD | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1181 AQUIDNECK AVE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028425255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018450840 | ||||||||
| FaxNumber: | 4016193752 | ||||||||
| Practice Location | |||||||||
| Address1: | 375 FAUNCE CORNER RD STE C | ||||||||
| Address2: | |||||||||
| City: | NORTH DARTMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027471258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7744257906 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2017 | ||||||||
| LastUpdateDate: | 07/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT02999 | RI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 25257 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.