Healthcare Provider Details

I. General information

NPI: 1710671243
Provider Name (Legal Business Name): EDWARD T REYNOLDS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 BLUEBONNET BLVD STE 1000
BATON ROUGE LA
70810-7827
US

IV. Provider business mailing address

8080 BLUEBONNET BLVD STE 1000
BATON ROUGE LA
70810-7827
US

V. Phone/Fax

Practice location:
  • Phone: 225-408-6633
  • Fax: 225-408-7965
Mailing address:
  • Phone: 225-408-6633
  • Fax: 225-408-7965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number11541
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: