Active NPI
Brock Ryan David Reichardt, ATC, LAT
- Athletic Trainer
- Stevens Point, WI
National Provider Identifier
1831662493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1806
- Practice address
- 4100 State Highway 66
Stevens Point, WI 54482-8410 - Phone
- (715) 346-2522
- NPI assigned
- Jan 7, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2189 | TN | |
| Athletic Trainer | 2255A2300X | 1806 | WI | Primary |
Addresses
Primary practice location
4100 State Highway 66
Stevens Point, WI 54482-8410
Mailing address
801 Gate LN Apt 417
Knoxville, TN 37909-3543
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2189 | TN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546819200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614297600000",
"number": "1831662493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 GATE LN APT 417",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379093543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 STATE HIGHWAY 66",
"city": "STEVENS POINT",
"state": "WI",
"postal_code": "544828410",
"telephone_number": "715-346-2522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REICHARDT",
"first_name": "BROCK",
"middle_name": "RYAN DAVID",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-07",
"last_updated": "2021-02-26",
"certification_date": "2021-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": "2189",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "1806",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stevens Point, WI
- Sophia Mae Reddan, MS, LAT, ATC
- Catherine Elizabeth Reed-Smith, RN
- Diane L Reetz, APNP
- Sarah Amanda Reeve, CCC-SLP
- Kathryn Marie Albers Regnier, CCC-SLP
- Marie L Reince, PTA
- Michelle Retzlaff, DPT
- Sondra Lynn Reynolds, CCC-SLP
- Angela M Rhode, APNP
- Richard W. Hurlbut (Mid Wisconsin Psychotherapy Associates)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.