Healthcare Provider Details

I. General information

NPI: 1760308142
Provider Name (Legal Business Name): KEVIN J REYES
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 WESTLAND DR SW
CLEVELAND TN
37311-8102
US

IV. Provider business mailing address

3925 ADKISSON DR NW APT 1624
CLEVELAND TN
37312-3155
US

V. Phone/Fax

Practice location:
  • Phone: 423-813-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: