Provider Demographics
NPI:1447788567
Name:REIFENRATH, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:REIFENRATH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 E MEADOW RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-7213
Mailing Address - Country:US
Mailing Address - Phone:1402-841-4411
Mailing Address - Fax:
Practice Address - Street 1:3200 RAASCH DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3455
Practice Address - Country:US
Practice Address - Phone:402-371-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist