Healthcare Provider Details

I. General information

NPI: 1104260587
Provider Name (Legal Business Name): JOEL ROBERT REEVES RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4448 EDGEWATER DR
ORLANDO FL
32804-1216
US

IV. Provider business mailing address

4448 EDGEWATER DR
ORLANDO FL
32804-1216
US

V. Phone/Fax

Practice location:
  • Phone: 407-513-3000
  • Fax: 407-515-6519
Mailing address:
  • Phone: 407-513-3000
  • Fax: 407-515-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT8646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: