Provider Demographics
NPI:1841473758
Name:REICHERT, ANGELLE W (PT)
Entity type:Individual
Prefix:MRS
First Name:ANGELLE
Middle Name:W
Last Name:REICHERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SHINLEAF CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4410
Mailing Address - Country:US
Mailing Address - Phone:864-297-3648
Mailing Address - Fax:
Practice Address - Street 1:1132 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3927
Practice Address - Country:US
Practice Address - Phone:864-250-0005
Practice Address - Fax:864-250-0028
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7822251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH0022Medicaid