Basic Information
| Provider Information | |||||||||
| NPI: | 1174115778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REISENFELD | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 PARK HILL DR | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224013377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406562786 | ||||||||
| FaxNumber: | 5403723510 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 GARRISONVILLE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | STAFFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225541615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403726737 | ||||||||
| FaxNumber: | 5403723510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2021 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305214153 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.