Healthcare Provider Details

I. General information

NPI: 1396577789
Provider Name (Legal Business Name): JOHN REED JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12920 SUMMERFIELD CROSSING BLVD
RIVERVIEW FL
33579-7210
US

IV. Provider business mailing address

34810 TELLURIDE LN
ZEPHYRHILLS FL
33541-2942
US

V. Phone/Fax

Practice location:
  • Phone: 813-998-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: