Basic Information
| Provider Information | |||||||||
| NPI: | 1881254613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REICHARD | ||||||||
| FirstName: | GLORY | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 W SYCAMORE ST | ||||||||
| Address2: | |||||||||
| City: | NEVADA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 647723151 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1784 ELKAHATCHEE RD | ||||||||
| Address2: | |||||||||
| City: | ALEXANDER CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350104800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563290868 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2019 | ||||||||
| LastUpdateDate: | 04/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 12329 | TN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PTH9387 | AL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2020009813 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.