Healthcare Provider Details

I. General information

NPI: 1902661515
Provider Name (Legal Business Name): REYES PERFORMANCE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
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 TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLOS REYES
Title or Position: OWNER
Credential: PT, DPT, SCS, MS
Phone: 512-297-3851