Healthcare Provider Details

I. General information

NPI: 1548030943
Provider Name (Legal Business Name): REESE PEDIATRIC PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N BAY DR
LYNN HAVEN FL
32444-3205
US

IV. Provider business mailing address

1305 N BAY DR
LYNN HAVEN FL
32444-3205
US

V. Phone/Fax

Practice location:
  • Phone: 808-291-3489
  • Fax: 850-610-6483
Mailing address:
  • Phone: 808-291-3489
  • Fax: 850-610-6483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DEBORAH JEAN REESE
Title or Position: OWNER/SOLE PROVIDER
Credential: PT, DPT, MPA
Phone: 808-291-3489