Healthcare Provider Details

I. General information

NPI: 1225832405
Provider Name (Legal Business Name): MICHAEL THOMAS REYNOLDS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 LINN ST
CINCINNATI OH
45203-1314
US

IV. Provider business mailing address

1019 LINN ST
CINCINNATI OH
45203-1314
US

V. Phone/Fax

Practice location:
  • Phone: 513-233-7100
  • Fax: 513-818-8637
Mailing address:
  • Phone: 443-942-1784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: