Healthcare Provider Details

I. General information

NPI: 1063226405
Provider Name (Legal Business Name): MRS. SAKEIA R REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 W DEKALB PIKE APT W431
KING OF PRUSSIA PA
19406-5202
US

IV. Provider business mailing address

251 W DEKALB PIKE APT W431
KING OF PRUSSIA PA
19406-5202
US

V. Phone/Fax

Practice location:
  • Phone: 215-500-5650
  • Fax: 484-476-1000
Mailing address:
  • Phone: 215-500-5650
  • Fax: 484-476-1000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: