Healthcare Provider Details

I. General information

NPI: 1023678711
Provider Name (Legal Business Name): TOM MATTHEW REID PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 CORKSCREW RD STE 15
ESTERO FL
33928-3217
US

IV. Provider business mailing address

9250 CORKSCREW RD STE 15
ESTERO FL
33928-3217
US

V. Phone/Fax

Practice location:
  • Phone: 239-687-3199
  • Fax:
Mailing address:
  • Phone: 239-687-3199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberPT23442
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: