Individual
RUSSELL LYLE JOHN REIMER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
109 N WISCONSIN ST, DE PERE, WI 54115
(920) 544-6840
Mailing address
1140 MORAINE WAY APT 39, GREEN BAY, WI 54303-9436
(920) 544-6840
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12421-46
WI
Other
Enumeration date
10/08/2024
Last updated
10/08/2024
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