Healthcare Provider Details

I. General information

NPI: 1023202900
Provider Name (Legal Business Name): DONALD HOWARD REYNOLDS AA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E CAPOVILLA AVE STE 105
LAS VEGAS NV
89119-4332
US

IV. Provider business mailing address

8621 BOLIN CT
LAS VEGAS NV
89123-0181
US

V. Phone/Fax

Practice location:
  • Phone: 702-260-7329
  • Fax:
Mailing address:
  • Phone: 702-222-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-0065
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: