Healthcare Provider Details

I. General information

NPI: 1679909154
Provider Name (Legal Business Name): NIKKI ANNE REIS ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 OCOEE CROWN POINT PKWY
OCOEE FL
34761-5060
US

IV. Provider business mailing address

1925 OCOEE CROWN POINT PKWY
OCOEE FL
34761-5060
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-3000
  • Fax: 407-905-3099
Mailing address:
  • Phone: 407-905-3000
  • Fax: 407-905-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL3546
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: