Healthcare Provider Details

I. General information

NPI: 1982514535
Provider Name (Legal Business Name): AIRA MONIQUE LAZARO REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 PARK ST 94 PARK ST
GLENS FALLS NY
12801
US

IV. Provider business mailing address

94 PARK ST
GLENS FALLS NY
12801
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number052754
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: