Healthcare Provider Details

I. General information

NPI: 1013439413
Provider Name (Legal Business Name): CARLOS REYES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 MARATHON BLVD STE 250
AUSTIN TX
78756-3755
US

IV. Provider business mailing address

4111 MARATHON BLVD STE 250
AUSTIN TX
78756-3755
US

V. Phone/Fax

Practice location:
  • Phone: 512-297-3851
  • Fax: 512-778-8860
Mailing address:
  • Phone: 512-297-3851
  • Fax: 512-778-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1299438
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1299438
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: